R323 – Pseudoarthrosis - radius or ulna
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R323 is a major surgical procedure involving the urogenital system, specifically ureteropyelostomy or anastomosis of the ureter. As a surgical service, its payment is governed by the general rules for surgery outlined in the Schedule of Benefits. This includes provisions for surgical assistants (R323B), anaesthesia (R323C), after-hours premiums, age-based premiums, and special visit premiums under applicable circumstances. A second assistant for this procedure is not automatically insured and requires special authorization.
When to Use
- Use R323 for the surgical repair of a ureteropyelostomy or ureteral anastomosis.
- Use R323 as the primary procedural code when performing definitive reconstruction of the ureter following injury or stricture.
Common Pitfalls
- Billing a hospital admission assessment on the same day as the decision to operate is a common rejection, as this is considered the major pre-operative visit.
- Attempting to bill for a second surgical assistant without prior medical consultant authorization will result in automatic rejection of the assistant's claim.
- Failing to document the Injury Severity Score (ISS) in the medical record will lead to the rejection of the E420 trauma premium.
Billing Tips
- Ensure the E420 trauma premium is only applied if the patient meets the specific age-based ISS thresholds (ISS > 12 for under 16; ISS > 15 for 16 and older) and is documented clearly.
- If a second assistant is medically necessary, submit the surgical claim with a formal letter of justification from the surgeon to the Ministry to secure the required authorization.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
The medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
For trauma premium eligibility, the medical record must list the Injury Severity Score (ISS).
The service of a second surgical assistant for R323 requires authorization by a medical consultant following submission of a letter from the surgeon outlining the reason the second assistant was required.
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