R319 – Graft to nose - autologous, bone or cartilage (without septorhinoplasty)
OHIP Radiology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving a graft to the nose. In addition to the common elements outlined in the Schedule of Benefits (see , ), this service includes all specific elements of a surgical procedure (), such as: - Supervising the preparation of and/or preparing the patient for the procedure(s). - Performing the procedure(s), by any method, or assisting another physician in the performance of the procedure and carrying out appropriate recovery room procedures, being responsible for the transfer of the patient to the recovery room, ongoing monitoring and detention during the immediate post-operative and recovery period. - Making arrangements for any related assessments or procedures, including obtaining any specimens from the patient and interpreting the results where appropriate. - Where indicated, making or supervising the making of arrangements for follow-up care, and post-procedure monitoring of the patient’s condition, including intervening, until the first post-operative visit. - Discussion with, providing any advice and information, including prescribing therapy, to the patient or patient’s representative, whether by telephone or otherwise, on matters related to the service. - Providing premises, equipment, supplies and personnel for the specific elements.
When to Use
- Use R319 when performing an isolated autologous bone or cartilage graft to the nose for structural support or reconstruction.
- Select this code when the procedure is distinct from a septorhinoplasty, as R319 is specifically for the graft component without the comprehensive septorhinoplasty elements.
Common Pitfalls
- Billing R319 without obtaining the mandatory written prior authorization from a Ministry of Health medical consultant will result in an automatic rejection.
- Submitting claims for C122, C123, C142, or C143 for visits within the 14-day post-operative period is a common error that triggers audit flags and payment recovery.
- Attempting to bill R319 for female patients will result in rejection, as the code is restricted to male patients only.
Billing Tips
- Ensure the operative report clearly details the source of the autologous graft, as this is essential for justifying the procedure under the R319 definition.
- If performing multiple procedures, remember that R319 is subject to the 85% rule under SP3:531 if performed alongside other surgical procedures during the same session.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
All insured services must be documented in appropriate medical records to establish that the service was provided, medically necessary, and is the service for which the account is submitted, as per :22.
For the trauma premium `E420` to be payable, the medical record must list the Injury Severity Score (ISS) as per :123.
Written prior authorization by a Ministry of Health medical consultant is required.
Male
When a second surgical assistant is required, the service is only eligible for payment following authorization by a medical consultant and requires submission of a letter from the surgeon outlining the reason the second assistant was required. See :104.
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