R324 – Osteotomy - radius and/or ulna with reconstruction congenital abnormality, synostosis etc.
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure listed under the Musculoskeletal System section of the Schedule of Benefits. Payment is made for the surgeon (suffix A), surgical assistant (suffix B), and anaesthesiologist (suffix C) as applicable. Fees for assistant and anaesthesia services are calculated based on a combination of basic units specific to the procedure and time units, as detailed in the General Preamble (, ).
When to Use
- Use R324 for corrective osteotomy procedures specifically addressing congenital limb abnormalities or synostosis of the radius or ulna.
- Select R324 when the surgical intent is the reconstruction of bone alignment or fusion release, distinguishing it from simple fracture management codes.
Common Pitfalls
- Billing R324 with R326 (osteotomy of other bones) without clear documentation of separate, distinct surgical sites may lead to rejection for unbundling.
- Attempting to bill a second surgical assistant without prior medical consultant authorization, as R324 is not on the pre-approved list for a second assistant.
- Failing to document the congenital nature of the condition, which is a requirement for the specific definition of R324.
Billing Tips
- Ensure the operative report explicitly details the reconstruction or synostosis correction to justify the use of R324 over more general orthopedic procedure codes.
- Always apply the appropriate age-based premium (e.g., AGE_PREMIUM_LT16Y) if the patient is under 16, as this is a common oversight for pediatric congenital surgeries.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
All insured services must be documented in appropriate records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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