R338 – Shortening metatarsal - two or more
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the shortening of two or more metatarsals. This procedure is listed under the Reconstruction section for foot and ankle deformities. The service is eligible for surgeon (A), assistant (B), and anaesthesia (C) fees. The assistant service (R338B) is calculated based on 6 base units plus time units. The anaesthesia service (R338C) is calculated based on 7 base units plus time units. Time unit calculation rules are detailed in the General Preamble of the Schedule of Benefits (, ).
When to Use
- Use R338 when performing a formal shortening osteotomy on two or more metatarsals, such as for the correction of brachymetatarsia or severe metatarsalgia.
- Select R338 instead of R337 when the surgical plan and operative report confirm that at least two distinct metatarsal bones were shortened during the same operative session.
Common Pitfalls
- Billing R338 alongside R337 is a common error; R338 is the comprehensive code for multiple metatarsals and already accounts for the complexity of the procedure.
- Failure to document the specific metatarsals addressed can lead to audit rejections, as the code explicitly requires 'two or more' to be eligible for the fee.
- Incorrectly applying after-hours premiums (E409/E410) to elective cosmetic foot surgeries, which do not meet the 'non-elective' or 'emergency' criteria required for these codes.
Billing Tips
- Ensure the operative note clearly identifies the specific metatarsals (e.g., 2nd and 3rd) to justify the use of the 'two or more' code over single-bone procedures.
- When billing for the assistant (R338B) or anaesthetist (R338C), ensure the start and end times are recorded precisely to accurately calculate the time units beyond the base units.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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