R316 – Proximal row carpectomy
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Proximal row carpectomy is a surgical procedure listed in the Musculoskeletal System section under Hand and Wrist. This procedure involves the excision (removal) of the proximal row of carpal bones. The service is claimable by the surgeon (R316A), a surgical assistant (R316B), and an anaesthetist (R316C). The fee for the assistant is based on 6 base units plus time units, and for the anaesthetist, it is based on 7 base units plus time units, as specified on page of the Schedule.
When to Use
- Use R316A for the definitive surgical excision of the proximal carpal row (scaphoid, lunate, triquetrum) in patients with advanced stage SLAC or SNAC wrist arthritis.
- Select R316A as the primary procedure code when performing a salvage procedure for Kienbock's disease where joint preservation is no longer viable.
Common Pitfalls
- Do not bill R316A in conjunction with other carpal bone excision codes, as R316A is intended to cover the entire proximal row; unbundling will trigger a rejection.
- Failure to document the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium will result in a clawback during audit.
- Attempting to claim E409/E410 non-elective premiums for elective procedures scheduled outside of standard operating hours is a common cause of claim rejection.
Billing Tips
- Ensure the anaesthetist includes all applicable extra unit codes (e.g., E022C for ASA status or E010C for BMI > 40) on the same claim as R316C to maximize the anaesthesia fee.
- When assisting at R316A, ensure the surgical assistant (R316B) explicitly links the E400B after-hours premium to the procedure start time to avoid manual review.
Effective: April 1, 2026
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 the service was provided, is the service submitted for payment, and was medically necessary.
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