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F085
F085 – Patella fracture - no reduction
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service covers the non-operative management of a fracture of the patella (kneecap). As a surgical procedure, this service requires a suffix 'A' when claimed by the performing physician as per ().
When to Use
- Use F085 for non-displaced patellar fractures where immobilization (e.g., cylinder cast or knee immobilizer) is the definitive treatment.
- Use this code when the fracture management does not involve manual or surgical reduction, distinguishing it from F087 which covers patellar fracture with reduction.
Common Pitfalls
- Failing to append the 'A' suffix to the code, which will result in an automatic rejection as this is categorized as a surgical procedure.
- Billing F085 in conjunction with a minor assessment code (e.g., A007) for the same encounter, which is generally considered unbundling unless the assessment is for an unrelated condition.
Billing Tips
- Ensure the 'A' suffix is included in the claim submission to satisfy the requirement for surgical procedure reporting under GP10.
- If the patient meets the trauma criteria, remember to append the E420 trauma premium to the F085 claim, provided the Injury Severity Score is documented in the chart.
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