R255 – Patella - open reduction - late
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service is for the late open reduction of the patella. This surgical procedure is typically performed for complex patellar fractures or dislocations that are not treated acutely. This service has fee allowances for the surgeon (A), surgical assistant (B), and anaesthesiologist (C). The fee for the assistant is calculated based on 6 basic units plus time units. The fee for the anaesthetist is calculated based on 7 basic units plus time units.
When to Use
- Use R255 for open reduction of patellar fractures that present in a delayed fashion, typically weeks or months after the initial injury, where fibrous union or malunion requires formal surgical intervention.
- Use this code for the surgical management of chronic patellar dislocations that have failed conservative management and require open reconstruction or realignment.
Common Pitfalls
- Do not bill R255 for acute patellar fractures; these should be billed under the appropriate acute fracture management codes (e.g., R254) to avoid rejection for incorrect service timing.
- Avoid billing R255 in conjunction with other major knee procedures without checking for 'multiple procedure' rules, as the Schedule of Benefits limits the basic units for assistants and anaesthetists to the major procedure only.
Billing Tips
- Ensure the operative report explicitly describes the 'late' nature of the procedure (e.g., non-union, malunion, or chronic dislocation) to satisfy the documentation requirements for this specific code.
- When claiming for surgical assistants or anaesthetists, ensure the basic units (6 for assistant, 7 for anaesthetist) are correctly applied to the time-based unit calculation to prevent underpayment.
Effective: April 1, 2026
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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