R222 – Incision and drainage - Humerus/clavicle/scapula
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs an incision and drainage of the humerus, clavicle, or scapula. This is a surgical procedure listed in the Musculoskeletal System section of the Schedule. The '#' prefix indicates that when this service is rendered in a hospital, the provision of premises, equipment, supplies, and personnel is funded by the hospital's global budget and cannot be charged to the patient ().
When to Use
- Use R222 for the surgical incision and drainage of an abscess or deep-seated infection specifically involving the humerus, clavicle, or scapula.
- Select R222 when the procedure involves debridement or drainage of the bone or periosteum in these specific anatomical locations, distinguishing it from superficial soft tissue drainage (which would fall under codes like S061).
- Use R222 for non-elective surgical management of osteomyelitis or septic arthritis involving the shoulder girdle or humerus.
Common Pitfalls
- Billing R222 for superficial skin or subcutaneous abscesses is an audit risk; ensure the operative report clearly documents involvement of the bone or periosteum.
- Attempting to bill R222 alongside other musculoskeletal procedures on the same site without appropriate 'multiple procedure' modifiers or documentation of separate incisions can lead to claim rejection.
- Failure to recognize the '#' prefix means you must not bill for tray fees or supplies when performing this in a hospital setting, as these are covered by the hospital's global budget.
Billing Tips
- If the procedure is performed on an emergency basis after hours, ensure you append the correct after-hours premium (E409 or E410) to the R222 fee, provided the criteria for non-elective status are met.
- Always document the specific anatomical site (humerus, clavicle, or scapula) in the claim notes to support the use of R222 over more generic musculoskeletal surgical codes.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
The '#' prefix indicates that for services performed in a hospital, the premises, equipment, supplies, and personnel are funded by the hospital global budget. For services with this prefix rendered outside a hospital or ICHSC, patients cannot be charged for these items as it would be contrary to the Integrated Community Health Services Centres Act, 2023 ().
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