R219 – Incision and drainage of phalanx/metacarpal/carpus
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure listed under the Musculoskeletal System section of the OHIP Schedule of Benefits. As a surgical code, it is subject to the general rules and definitions outlined in the General Preamble (-). This includes regulations for how fees are calculated for the surgeon (A suffix), surgical assistant (B suffix), and anaesthesiologist (C suffix), as well as eligibility for various add-on premiums such as those for after-hours services, patient age, and trauma.
When to Use
- Use R219 for the formal incision and drainage of a deep-seated infection, such as a paronychia requiring surgical release or a deep space abscess within the phalanx, metacarpal, or carpal regions.
- Select R219 when the procedure involves a formal surgical incision rather than a simple bedside aspiration or minor puncture, which would be more appropriately billed under a minor assessment or procedure code.
Common Pitfalls
- Billing R219 in conjunction with a minor assessment code (A007) for the same encounter is a common audit trigger; the assessment is generally considered included in the surgical fee unless a separate, unrelated problem is addressed.
- Confusing R219 with R218 (Incision and drainage of hand/finger abscess) can lead to rejections; ensure the anatomical site specifically involves the phalanx, metacarpal, or carpal bones to justify the higher complexity of R219.
Billing Tips
- If performing multiple procedures during the same session, remember that the surgical assistant and anaesthesiologist fees are calculated based on the major procedure only, as per GP85:99.
- Always document the specific anatomical location and the depth of the incision, as this is essential to justify the use of R219 over less complex musculoskeletal procedure codes.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Medical records must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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