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R284
R284 – Mandibular condyle
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of the mandibular condyle, a surgical procedure performed on the jaw. This code applies to the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C). Payment for the assistant and anaesthetist is calculated based on a combination of basic units and time units.
When to Use
- Use R284A for the formal excision of the mandibular condyle, distinct from simple condylectomy procedures covered under other musculoskeletal codes.
- Select this code when the procedure is performed as a primary surgical intervention for pathology or structural deformity of the condyle.
Common Pitfalls
- Do not attempt to bill R284A alongside R272 or R280 for the same anatomical site, as this will trigger a duplicate service or unbundling rejection.
- Failure to document the specific Injury Severity Score (ISS) when attempting to claim the E420 trauma premium will result in automatic claim rejection.
- Assuming a second assistant is automatically covered; R284 is not on the pre-approved list for a second assistant, requiring prior authorization and a letter of justification.
Billing Tips
- Ensure the procedure start time is clearly documented in the operative report to support the accurate application of E409, E410, or equivalent assistant/anaesthesia after-hours premiums.
- When billing for paediatric patients, always verify the age-based premium percentage against the specific age brackets defined in the GP64 schedule to avoid under-billing.
Provider Fee$276.55
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
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