R293 – Bone tumour - extensive with replacement
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This fee code represents a surgical procedure performed on the musculoskeletal system. The fee is for the surgeon's service (suffix A). Assistant (suffix B) and anaesthetist (suffix C) services are billed separately. The calculation of assistant and anaesthetist fees is based on basic units (specific to the procedure, not provided in context) and time units as outlined in the General Preamble (, ). Various premiums for age, after-hours services, and patient complexity may also apply.
When to Use
- Use R293 for the definitive surgical resection of a bone tumour that necessitates a formal reconstruction or replacement, such as an endoprosthetic replacement or massive allograft.
- Select R293 when the procedure involves extensive surgical excision of a neoplasm where the complexity of the replacement component is the primary driver of the surgical time and effort, distinguishing it from simple curettage or minor excision codes.
Common Pitfalls
- Billing R293 for simple bone biopsies or minor excisions; ensure the operative report clearly details the 'extensive' nature of the tumour and the specific 'replacement' hardware used to justify this higher-value code.
- Failing to document the specific anatomical location and tumour pathology, which are essential for audit purposes to substantiate the 'extensive' classification versus standard orthopaedic procedures.
- Incorrectly bundling the replacement hardware or graft preparation; while the surgeon's fee is fixed, ensure that any secondary procedures performed during the same session are reviewed against the Multiple Procedure Rule to avoid automatic claim rejections.
Billing Tips
- Always append the appropriate age-based premium (e.g., AGE_PREMIUM_U16Y) if the patient qualifies, as R293 is a surgical procedure and these premiums are additive to the base fee.
- If the procedure is performed on an emergency basis after hours, ensure the correct non-elective premium (E409A or E410A) is applied to the surgeon's claim to maximize the procedural reimbursement.
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 to establish that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary.
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