R228 – Acute incision and drainage
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the incision and drainage of an acute condition, typically an abscess or infection, within the elbow or forearm regions. This service is listed in the Musculoskeletal System Surgical Procedures section of the Schedule. The fee for the surgeon is a flat rate. When an assistant is required, the service (R228B) is calculated using 6 base units plus time units. When anaesthesia is required, the service (R228C) is calculated using 7 base units plus time units. For rules on surgical assistance and anaesthesia fee calculation, see pages - and - respectively.
When to Use
- Use R228 for the acute incision and drainage of a localized abscess or infection specifically located within the elbow or forearm compartments.
- Use R228 when the procedure is performed as a standalone surgical intervention for acute musculoskeletal infection, rather than as part of a more extensive debridement or fracture fixation procedure.
Common Pitfalls
- Billing an office visit (A007) on the same day as R228 will result in a rejection, as the assessment is considered included in the surgical fee unless it qualifies as a major pre-operative consultation.
- Confusing R228 with R229 (Incision and drainage of deep abscess) or R231 (Incision and drainage of bursa); ensure the anatomical site and depth match the specific definition of R228 to avoid audit recovery.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, which is a common trigger for manual review and rejection.
Billing Tips
- If the decision to operate is made during the encounter, bill the appropriate consultation code (e.g., A005) in addition to R228, ensuring the claim reflects the 'major pre-operative assessment' status.
- Always append the suffix 'B' for surgical assistants or 'C' for anaesthesia services to the base code R228 to ensure the correct base units are applied for those providers.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Anaesthesia basic units: 7
Assistant basic units: 6
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