F143 – Middle 1/4 facial
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical reduction for a middle one-quarter (¼) facial fracture. The service is eligible for suffixes A (surgeon), B (assistant), and C (anaesthetist). Assistant services are compensated based on 6 base units plus time units. Anaesthesia services are compensated based on 8 base units plus time units (see Unit-Based Information for details). This procedure may be billed with the add-on code E830 for the use of mini-plate(s), per major fracture line. The Schedule notes that where mini-plate(s) are used, one mini-plate fee should be billed per each major fracture line (e.g. infraorbital, malar-zygomatic, nasal-frontal, LeFort I, LeFort II and III), per major fracture line per side (see ).
When to Use
- Use F143 for the surgical reduction of middle one-quarter facial fractures, such as isolated zygomatic or LeFort-type fractures, where F144 (which covers more extensive or complex facial reconstruction) is not applicable.
- Select F143 when the procedure involves the reduction of a fracture specifically within the mid-face region, ensuring the clinical documentation clearly identifies the anatomical site (e.g., infraorbital or malar-zygomatic) to justify the code selection.
Common Pitfalls
- Failing to bill E830 for each distinct major fracture line per side; ensure that if multiple plates are used across different fracture lines, each is claimed as a separate unit of E830.
- Incorrectly bundling the use of mini-plates into the base fee of F143; E830 is a distinct add-on code that must be explicitly claimed to receive compensation for the hardware used.
- Misinterpreting the 'per side' rule for E830, which leads to under-billing when bilateral fractures are repaired using mini-plates on both sides.
Billing Tips
- Always itemize E830 claims by specifying the exact fracture lines treated (e.g., 'right infraorbital' and 'left malar-zygomatic') to prevent audit queries regarding the quantity of add-on units.
- Verify if the patient meets the criteria for the Trauma Premium (E420) if the F143 procedure is performed within 24 hours of a major injury, as this can be claimed in addition to the surgical fee if the Injury Severity Score (ISS) requirements are met.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
** Where mini-plate(s) are used, one mini-plate fee per each major fracture line (e.g. infraorbital, malar-zygomatic, nasal-frontal, LeFort I, LeFort II and III) (per major fracture line per side) should be billed.
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