R292 – Excision of humerus head
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of the head of the humerus. This surgical procedure is listed with a '#' prefix, which indicates that when performed in a hospital or Integrated Community Health Services Centre (ICHSC), the cost of premises, equipment, supplies, and personnel are not billed by the physician but are funded through the institution (). The service is eligible for surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C) fees, each calculated based on a combination of basic and time units.
When to Use
- Use R292 for the formal surgical excision of the humeral head, typically performed for severe comminuted fractures or end-stage avascular necrosis.
- Select R292 when the procedure is a standalone excision, distinguishing it from more comprehensive procedures like hemiarthroplasty or total shoulder arthroplasty which carry different codes.
Common Pitfalls
- Billing R292 alongside a more comprehensive shoulder reconstruction code can trigger a rejection for unbundling; ensure the procedure performed matches the specific scope of R292.
- Failure to document the specific clinical indication for the excision can lead to audit scrutiny, as this code is often subject to review for medical necessity compared to joint-preserving alternatives.
Billing Tips
- Ensure the operative report explicitly details the excision of the humeral head to support the claim, as the '#' prefix signifies institutional funding for the facility and requires clear evidence of the surgeon's specific procedural work.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Standard medical record requirements apply as per . An operative report is typically required for surgical procedures.
This procedure is denoted by the '#' prefix. When performed in a hospital, the premises, equipment, supplies, and personnel used to perform all elements of the service are funded by the hospital global budget. See .
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