F083 – Fibula - closed reduction
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving the closed reduction of a fracture of the fibula. This procedure does not involve a surgical incision to expose the fracture site. As a surgical procedure, it includes all common and specific elements of surgical services, such as pre-operative assessment, post-operative care, and arranging follow-up. The fee is payable to the surgeon performing the procedure (suffix A), with separate calculations for assistant (suffix B) and anaesthetist (suffix C) services.
When to Use
- Use F083 for the closed reduction of a fibular fracture where no surgical incision is made to access the fracture site.
- Use this code for isolated fibular fractures managed in the emergency department or operating room without open reduction internal fixation (ORIF).
- Do not use F083 if the procedure involves an open approach to the bone; in those cases, refer to the appropriate open reduction codes (e.g., F082 or F084).
Common Pitfalls
- Billing F083 alongside an open reduction code for the same limb is a common audit trigger for unbundling.
- Claiming a surgical assistant fee (F083B) without explicit documentation justifying the necessity of assistance will lead to rejection or recovery.
- Failure to document the Injury Severity Score (ISS) in the medical record when claiming the trauma premium (E420) will result in automatic rejection of the premium.
Billing Tips
- When a surgical assistant is required for F083, you must bill the assistant fee using code M400B and provide a letter of justification to the medical consultant for authorization.
- Ensure the procedure start time is accurately recorded to correctly apply after-hours premiums (E409, E410) or night-time anaesthesia premiums (E401C).
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records to establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
If a trauma premium (E420) is claimed, the medical record must list the Injury Severity Score (ISS).
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