R057 – Appendage or tissue re-vascularization involving microanastomosis
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R057 is a surgical procedure listed under the Integumentary System Surgical Procedures section. Payment includes fees for the surgeon (suffix A), anaesthetist (suffix C), and surgical assistant (suffix B), calculated based on basic and time units. Notably, a second surgical assistant's services are payable for this procedure without requiring special authorization from a medical consultant. The service is eligible for various premiums, including age-based premiums for patients under 16, after-hours premiums for non-elective procedures, and the trauma premium for severely injured patients, subject to specific criteria.
When to Use
- Use R057 for complex digit or limb re-vascularization requiring microsurgical anastomosis, distinguishing it from standard vascular repairs like R055 or R056 which do not involve micro-techniques.
- Select R057 when performing free tissue transfer or replantation where the primary surgical focus is the restoration of blood flow via microvascular anastomosis.
Common Pitfalls
- Failing to document the use of an operating microscope, which is a clinical requirement to justify the microanastomosis component of R057.
- Attempting to bill R057 alongside other vascular repair codes (e.g., R055) for the same vessel; these are generally considered inclusive and will trigger a rejection for unbundling.
- Neglecting to include the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, which is a frequent cause of audit recovery.
Billing Tips
- Since R057 allows for a second surgical assistant without prior authorization, ensure the second assistant's claim is clearly linked to the primary procedure code to avoid manual review delays.
- Always verify the start time of the procedure to accurately apply E400B/E401B for assistants or E400C/E401C for anaesthesiologists, as these premiums are based on the commencement of the case.
No fee information available.
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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