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E494 – Debridement (degenerative cartilage)

OHIP Musculoskeletal System Surgical Procedures Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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Substantial debridement of one or more focal flaps of unstable degenerative articular cartilage causing mechanical symptoms. This service includes, when rendered, any associated synovectomy, meniscal trimming, and/or chondroplasty. Payment is not eligible for the debridement of cartilage flaps for the purpose of surgical visualization alone. See for full details.
Pre-authorization required
When E494 or E495 are claimed with R687, it is recommended that the intra-articular pathology be documented with pre- and post-procedural photographic images taken during arthroscopy which are archived in the permanent medical record where possible.
E476E491E492E493E478E498E489E495R687

Prior approval may be granted for E494 or E495 in patients with Kellgren-Lawrence grade 3 or 4 osteoarthritis (see Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res. 2016 Aug; 474(8):1886-93) if the clinical record supports: a. Significant functional impairment caused by an unstable articular chondral flap or degenerative meniscal tear which has not responded to a minimum of six months active non-surgical treatment; and b. the patient is not a current candidate for knee realignment or arthroplasty.

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