R218 – Sequestrectomy - Phalanx/metacarpal/carpus
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R218 is a fee code representing a surgical procedure within the Musculoskeletal System section of the OHIP Schedule of Benefits. The service includes the pre-operative evaluation, the operation itself, and normal post-operative care. Payment is claimed using a suffix to denote the physician's role: Suffix 'A' for the performing surgeon, Suffix 'B' for the surgical assistant, and Suffix 'C' for the anaesthesiologist. The fees for assistant and anaesthetist services are calculated using a combination of basic units (specific to the procedure) and time units, as detailed in the General Preamble. Additional premiums may apply for services rendered after hours, to specific age groups, or under other specified circumstances.
When to Use
- Use R218 specifically for the surgical removal of a sequestrum from the phalanx, metacarpal, or carpal bones.
- Select R218 when performing a debridement that specifically targets a necrotic bone fragment (sequestrum) rather than general soft tissue debridement.
Common Pitfalls
- Do not bill R218 in conjunction with general debridement codes for the same site, as the sequestrectomy is considered the definitive procedure.
- Avoid billing R218 for simple wound care or dressing changes; it is strictly a surgical procedure requiring formal operative documentation of bone removal.
- R218 is not on the pre-approved list for a second surgical assistant; billing for one without prior authorization will result in a rejection.
Billing Tips
- Ensure the operative report explicitly mentions the identification and removal of a sequestrum to justify the use of R218 over less specific musculoskeletal procedure codes.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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