E059 – Revision/repair following previous reconstruction of knee ligaments
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This premium is payable in addition to `R542 when the procedure involves the revision or repair of a previously reconstructed knee ligament. It increases the total fee payable for R542` by 30%. The 30% increase is applied to the fee for the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C).
When to Use
- Use E059 when performing a revision ACL or PCL reconstruction where the primary graft has failed and requires replacement or significant repair.
- Apply this code when addressing a failed ligament reconstruction that necessitates a new graft construct, provided the primary procedure was coded as R542.
Common Pitfalls
- Do not bill E059 for primary ligament reconstructions; it is strictly reserved for revision cases following a previously documented reconstruction.
- Avoid billing E059 if the primary procedure was not billed as R542, as it is technically invalid without the base code.
Billing Tips
- Ensure the operative report explicitly states the presence of prior hardware or graft remnants to justify the revision status required for E059.
- Verify that the 30% premium is correctly applied to the R542 fee in your billing software, as it must be linked to the base procedure to trigger the correct payment.
Percentage Premium: 0.3%
This code applies a percentage increase to the base procedure fee
Effective: July 1, 2013
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
PercentageIncrease
Musculoskeletal System Surgical Procedures, Other Premiums (including After Hours Procedure Premiums)
to R542 - add 30%
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