R363 – Pseudoarthrosis - Malleoli
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This surgical procedure involves the repair and reconstruction of a pseudoarthrosis, or non-union, of the malleoli. The malleoli are the bony prominences on each side of the ankle. This service is listed under the Musculoskeletal System section for foot and ankle reconstruction. When billed by a surgical assistant (suffix B), the service has 6 base units. When billed by an anaesthesiologist (suffix C), the service has 7 base units.
When to Use
- Use R363 specifically for the surgical repair of a symptomatic non-union (pseudoarthrosis) of the medial or lateral malleolus.
- Select this code when performing an open reduction and internal fixation (ORIF) or bone grafting procedure specifically to address a failed primary healing of a malleolar fracture.
Common Pitfalls
- Do not bill R363 for a primary malleolar fracture fixation; use the appropriate fracture management codes instead.
- Avoid billing R363 in conjunction with other ankle reconstruction codes unless distinct, separate procedures are performed and documented, as this may trigger a claim rejection for unbundling.
- Failure to document the specific diagnosis of 'pseudoarthrosis' or 'non-union' in the operative report will lead to audit recovery, as the code is not intended for routine fracture repair.
Billing Tips
- Ensure the operative report clearly details the presence of fibrous tissue or gap at the fracture site to justify the use of R363 over standard fracture repair codes.
- If the procedure is performed as part of a multi-trauma case meeting the criteria for E420, ensure the Injury Severity Score is explicitly recorded in the chart to support the 50% premium claim.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate medical records, establishing that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary.
For trauma cases eligible for the E420 premium, the medical record must list the Injury Severity Score (ISS).
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