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F104
F104 – Ankle fracture with tibial Plafond burst - closed reduction and external fixation
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
When to Use
- Use F104 specifically for closed reduction and external fixation of an ankle fracture involving a tibial plafond burst.
- Do not use this code for simple ankle fractures or open reductions; it is strictly limited to closed reduction with external fixation for this specific injury pattern.
Common Pitfalls
- Billing F104 for a closed reduction without the application of an external fixator will result in automatic rejection as per the Schedule of Benefits.
- Attempting to bill F104 alongside E555 is prohibited; the system will reject the claim due to the explicit restriction between these two codes.
Billing Tips
- Ensure the operative report explicitly documents both the closed reduction technique and the application of the external fixation device to support the claim during potential audits.
- If performing multiple procedures under the same anaesthetic, remember that the surgical assistant and anaesthesia units are determined solely by the major procedure code.
Provider Fee$363.40
Surgical Assistant Fee$77.46
Anaesthetist Fee$95.76
Non-Anaesthetist Fee$95.76
Effective: April 1, 2026
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records establishing 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.
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