R345 – Carpal bone, other than scaphoid
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service is for the surgical reconstruction of a carpal bone (other than the scaphoid) to treat pseudoarthrosis, non-union, or avascular necrosis. Per the note on page , the fee for R345 inherently includes the work of fixation and performing a non-vascularized bone graft. An additional fee, E497, can be claimed if a pedicled vascularized bone graft is used instead of, or in addition to, the standard non-vascularized graft.
When to Use
- Use R345 for the surgical reconstruction of carpal bones such as the lunate or triquetrum when addressing established non-union or avascular necrosis.
- Use R345 when performing a reconstruction that requires both internal fixation and a non-vascularized bone graft as a single integrated procedure.
Common Pitfalls
- Do not bill F019 (bone graft) or Z279 (internal fixation) separately, as these components are bundled into the R345 fee and will trigger automatic claim rejections.
- Ensure the procedure is for a carpal bone other than the scaphoid; scaphoid-specific reconstructions must be billed under their respective codes to avoid audit discrepancies.
Billing Tips
- If you utilize a pedicled vascularized bone graft, ensure you append E497 to the R345 claim to capture the additional $526.40 fee, as this is not included in the base R345 rate.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Must include fixation and a non-vascularized bone graft.
Standard medical record requirements as per must be met.
1. R322 and R345 must include fixation and a non-vascularized bone graft.
2. E497 is payable in addition to R322 and R345 if a pedicled vascularized bone graft is used in addition to, or in place of a non-vascularized bone graft.
3. F019 and Z279 rendered in conjunction with R322 and R345 are not eligible for payment.
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