E485 – Arthroscopic capsular release for frozen shoulder
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
An add-on fee payable in addition to `R684` (Shoulder arthroscopy setup) for performing an arthroscopic capsular release for a frozen shoulder. This procedure is subject to the general rules for surgical procedures and arthroscopy as outlined in the Schedule. Per , this add-on is not payable if the capsular release is a generally accepted component of another shoulder procedure performed arthroscopically during the same session.
When to Use
- Use E485 as an add-on to R684 when performing an isolated arthroscopic capsular release specifically for the treatment of adhesive capsulitis (frozen shoulder).
- Use this code when the capsular release is the primary therapeutic intervention performed during the shoulder arthroscopy session.
Common Pitfalls
- Billing E485 alongside other primary shoulder arthroscopy procedures where capsular release is considered an inherent, standard component of that procedure, leading to automatic rejection.
- Attempting to bill E485 without the mandatory R684 setup code, which is required for the add-on to be processed.
- Failure to document the specific diagnosis of frozen shoulder, which is essential to justify the add-on fee during a potential audit.
Billing Tips
- Ensure the operative report explicitly details the capsular release technique to distinguish it from standard diagnostic or other therapeutic arthroscopic steps that are already bundled into primary procedure codes.
- Verify that the primary procedure code billed with R684 does not already include capsular release as a generally accepted component per the Schedule of Benefits to avoid claim denials.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
A shoulder procedure listed in the Shoulder section of the Schedule performed arthroscopically is eligible for payment in addition to `R684 if that procedure is not described as a component of R684 or described by an E-add-on code to R684`.
Arthroscopic E-add-on codes listed below are not eligible for payment in addition to `R684` when the service described by the E-code is a generally accepted component of a procedure described in Note #1.
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