R344 – Tibial and femoral stapling
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R344 is a surgical procedure listed under the Urogenital and Urinary Surgical Procedures section of the Schedule of Benefits. As a surgical service, the fee includes all constituent and common elements of insured services as outlined in the General Preamble (, ). The service may be performed by a surgeon (suffix A), or involve an assistant (suffix B) and/or an anaesthesiologist (suffix C), each with specific fee calculation rules based on basic and time units.
When to Use
- Use R344 for the specific surgical application of staples to the tibia and femur, typically in the context of orthopedic stabilization or growth modulation procedures.
- Select R344 when the procedure is performed as a standalone surgical intervention, ensuring it is not bundled into a more comprehensive orthopedic reconstruction code.
Common Pitfalls
- Billing R344 alongside other major orthopedic procedures without ensuring the 'multiple procedure' rule is applied, which may lead to automatic reductions or audit flags.
- Failing to document the specific anatomical site and the necessity of the stapling, which is critical for justifying the surgical fee during post-payment review.
Billing Tips
- Ensure that if an assistant or anaesthesiologist is involved, the basic units are calculated based on the major procedure performed during the same anaesthetic session to avoid claim rejection.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
All insured services must be documented in the patient's medical record, establishing that the service was provided, medically necessary, and is the same service for which the account is submitted.
For surgical procedures, an appropriate operative report is required.
The anaesthesia basic units (6) and assistant basic units (6) are calculated from the fee schedule values and the unit fees specified in the General Preamble (, ). Anaesthetist: 105.06 / 15.49 = 6.78 units. Assistant: 84.84 / 12.51 = 6.78 units. Rounded to 6.
Use of a second assistant requires authorization by a medical consultant and submission of a letter from the surgeon outlining the reason.
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