R269 – Bone - incision and drainage
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs an incision and drainage of a bone, as listed in the Musculoskeletal System section under Pelvis and Hip. This is a surgical procedure that includes payment components for a surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C).
When to Use
- Use R269 for the surgical incision and drainage of an abscess or infection specifically involving the bone of the pelvis or hip.
- Select R269 when the procedure is limited to drainage and debridement of the bone, as opposed to more extensive procedures like sequestrectomy or saucerization which may require different coding.
Common Pitfalls
- Billing R269 for soft tissue drainage; if the infection is limited to the skin or subcutaneous tissue, this code is inappropriate and will be flagged during audit.
- Failing to document the specific bone involved in the pelvis or hip, which is required to justify the use of this musculoskeletal surgical code over general incision and drainage codes.
- Attempting to unbundle the procedure by billing additional minor surgical codes for the same site; R269 is intended to be the comprehensive fee for the drainage procedure.
Billing Tips
- Ensure the operative report explicitly describes the involvement of the bone to support the claim, as OHIP auditors specifically look for evidence of bone-level pathology for R269.
- If the procedure is performed on an emergency basis after hours, ensure the claim includes the correct E-series premium (E409 or E410) to maximize the procedural fee.
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 that establish: 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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