R235 – Osteotomy - glenoid
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R235 is a fee code for a surgical procedure within the Musculoskeletal System section of the OHIP Schedule of Benefits. The fee for the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C) are all calculated based on a combination of basic and time-based units. The service includes all typical components of a surgical procedure, including pre-operative evaluation and post-operative follow-up care as outlined in the General Preamble. Additional fee premiums may be applicable, such as those for services performed after hours, on trauma patients, or for patients in specific age groups (see Age-Based Fee Premiums on ). The specific details of this surgical procedure are not available in the provided context.
When to Use
- Use R235 for a formal osteotomy of the glenoid performed to correct glenoid dysplasia or version abnormalities.
- Select R235 when the procedure involves a surgical cut and repositioning of the glenoid bone, distinguishing it from simple debridement or soft tissue procedures.
Common Pitfalls
- Billing R235 alongside soft tissue stabilization procedures (e.g., Bankart repair) without checking for 'incidental' or 'inclusive' status, as the Schedule of Benefits often bundles these.
- Failing to document the specific osteotomy technique, which can lead to audit rejections if the procedure is later reclassified as a less complex arthroscopic intervention.
Billing Tips
- Always ensure the operative report explicitly details the osteotomy (bone cut and fixation) to justify the R235 fee over lower-valued arthroscopic 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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