F097 – Femur - cast
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the application of a cast to the femur. This service is eligible for billing with 'A' (surgeon), 'B' (assistant), or 'C' (anaesthetist) suffixes. The unit values for calculating assistant and anaesthesia fees are as follows: - Assistant: 6 basic units (:, :) - Anaesthesia: 6 basic units (:, :) The total fee for assistant and anaesthesia services is calculated by adding time units to these basic units.
When to Use
- Use F097 for the definitive application of a cast to the femur, typically following fracture reduction or stabilization.
- Distinguish from F095 (Femur - reduction) or F096 (Femur - traction) when the primary service provided is the casting procedure itself rather than the reduction or traction setup.
Common Pitfalls
- Billing F097 in addition to a fracture reduction code (e.g., F095) is often considered inclusive; verify if the cast application is part of the global surgical fee for the reduction.
- Failure to document the specific type of cast or the clinical necessity for the immobilization can lead to recovery during an audit.
Billing Tips
- Ensure that if an assistant or anaesthetist is required, you correctly calculate the total fee by adding the time-based units to the 6 basic units defined for F097.
- Always verify if the patient qualifies for age-based surgical premiums, as these apply as a percentage increase to the base fee of F097.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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