R265 – Osteotomy - infant
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R265 is a surgical procedure for an osteotomy of the pelvis, specifically for an infant patient. The fee is calculated based on surgical, assistant, and anaesthesia units.
When to Use
- Use R265 specifically for pelvic osteotomy procedures performed on patients aged 29 days up to 2 years.
- Select R265 when performing corrective pelvic surgery for congenital hip dysplasia in infants, ensuring the patient age is strictly within the defined range.
Common Pitfalls
- Billing R265 for patients under 29 days or 2 years and older will result in automatic rejection due to the strict age-based eligibility criteria.
- Failure to document exact start and end times for the surgical assistant or anaesthesiologist will lead to audit recovery, as these are required for unit-based calculations.
Billing Tips
- If the procedure is performed on a patient less than 30 days old, ensure the 30% age-based premium is applied to the surgical fee as per the R265 billing interactions.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
For anaesthesia services, the physician must record the start and end times of the service in the patient's medical record.
For surgical assistant services, the physician must record the start and end times of the service in the patient's medical record.
If claiming the Trauma premium (E420), the Injury Severity Score (ISS) must be listed in the medical record.
years
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.