R287 – Radial head excision
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service is for the open reduction of a dislocated prosthetic joint. The fee listed is for the surgeon's professional service (suffix A) and includes the major pre-operative visit where the decision to operate is made, and normal post-operative care. Anaesthesia (Suffix C): The anaesthesia fee is calculated based on a unit system. For R287, the service has 8 basic units. Time units are added based on the duration of the anaesthetic service. The total units are multiplied by the anaesthesiologist unit fee ($15.49 as of Feb 2025). Surgical Assistance (Suffix B): The surgical assistant's fee is also unit-based. For R287, the service has approximately 7 basic units. Time units are added based on the duration of assistance. The total units are multiplied by the surgical assistant unit fee ($12.51 as of Feb 2025). This service is subject to all general rules outlined in the General Preamble of the Schedule of Benefits, including rules for multiple procedures, cancelled surgery, and supervision of medical trainees.
When to Use
- Use R287 for the open reduction of a dislocated prosthetic radial head joint when the procedure is performed as a standalone surgical intervention.
- Use this code for the surgical management of a prosthetic joint dislocation where the complexity necessitates an open approach rather than a closed reduction under sedation.
Common Pitfalls
- Attempting to bill a separate consultation fee on the same day as R287; the major pre-operative decision-making visit is already included in the procedural fee.
- Failing to document the specific start and end times for the procedure, which is required to calculate the time-based units for both the anaesthesiologist (Suffix C) and the surgical assistant (Suffix B).
- Submitting R287 alongside other surgical procedures without accounting for the multiple procedure rules, which may result in the reduction of the basic units for the assistant and anaesthesiologist.
Billing Tips
- Ensure that the surgical assistant and anaesthesiologist claims are linked to the same start time as the surgeon's claim to avoid discrepancies in after-hours premium (E400/E401 series) eligibility.
- If the procedure is performed on a trauma patient, ensure the Injury Severity Score (ISS) is clearly documented in the chart to support the 50% E420 trauma premium.
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. 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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