R281 – Ulna replacement (lower end)
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R281 is a service listed under Musculoskeletal System Surgical Procedures for the elbow and forearm. It is specifically an arthroplasty procedure for the replacement of the lower end of the ulna. As a surgical procedure, it is eligible for payment to the operating surgeon (suffix A), a surgical assistant (suffix B), and an anaesthesiologist (suffix C), with associated unit calculations for assistant and anaesthesia services as outlined on -.
When to Use
- Use R281 for the surgical replacement of the distal ulna, typically performed as part of a Darrach procedure or when utilizing a specific ulnar head implant.
- Select R281 when the primary intent of the procedure is the arthroplasty of the distal radioulnar joint (DRUJ) specifically involving the ulna, rather than a general wrist arthroplasty.
Common Pitfalls
- Do not bill R281 in conjunction with R280 (excision of distal ulna) as R281 is the definitive replacement procedure and they are mutually exclusive for the same anatomical site.
- Avoid billing R281 as a bilateral procedure without the appropriate 'B' suffix and modifier, as the OHIP system requires specific coding for bilateral musculoskeletal surgeries to trigger the correct payment reduction.
- Failure to document the specific implant type or the necessity of the replacement can lead to audit recovery if the procedure is later reclassified as a simple excision.
Billing Tips
- Ensure the surgical assistant and anaesthesiologist claims reference R281 as the primary procedure to ensure the correct unit calculations are applied per the Schedule of Benefits.
- If the procedure is performed on an emergency basis (e.g., following severe trauma), ensure the trauma premium E420 is applied instead of after-hours premiums, as they are mutually exclusive.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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