F146 – Complicated mandible procedure
OHIP Anaesthesia Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical procedure for a complicated fracture of the mandible. As per , this service is designated for Independent Consideration (IC), meaning it does not have a specified fee. Claims must be submitted with a supporting letter explaining the amount of the fee claimed, and must include an appropriate operative or consultation report, and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule. The fees for the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C) are all subject to this process.
When to Use
- Use F146 for complex, multi-fragmentary mandible fractures that require extensive open reduction and internal fixation (ORIF) beyond the scope of standard fracture codes like F144.
- Select this code when the procedure involves significant reconstruction, such as the use of bone grafts or complex hardware spanning multiple segments, which cannot be adequately captured by routine mandibular fracture codes.
Common Pitfalls
- Failure to submit a detailed operative report and a comparative analysis letter will result in an automatic rejection or a significantly reduced payment by the medical consultant.
- Submitting F146 without explicitly justifying why the procedure exceeds the complexity of standard, non-IC mandibular fracture codes often leads to claims being downgraded to standard fee levels.
- Forgetting to submit the assistant's claim under M400B instead of F146B, which is a common administrative error that causes immediate rejection of the assistant's portion.
Billing Tips
- When writing your supporting letter, explicitly compare the time, technical difficulty, and instrumentation required for F146 against a standard, non-IC mandibular fracture code to provide the medical consultant with a clear benchmark for valuation.
- Ensure the operative report highlights specific 'complicated' factors, such as comminution, soft tissue loss, or the necessity for specialized fixation, to justify the IC status.
No fee information available.
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
For anaesthesia services (suffix C) where basic units are listed as IC, the amount payable is calculated by adding the appropriate time units to the basic units listed for a comparable procedure (taking into account the region, modifying conditions, or techniques).
For assistant services (suffix B) where basic units are listed as IC, payment is determined by a medical consultant following submission of a letter from the surgeon outlining the reason the assistant was required and details of the service provided. Submit claims for this type of service using fee code M400B.
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