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R364
R364 – Pelvis reconstruction
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the reconstruction of a pseudoarthrosis of the pelvis. This service is eligible for surgeon, assistant, and anaesthetist services. The assistant and anaesthetist fees are calculated based on a combination of basic and time units.
When to Use
- Use R364 specifically for the surgical reconstruction of a confirmed pelvic pseudoarthrosis, distinguishing it from general pelvic fracture fixation codes like R330.
- Apply this code when the clinical intent is the restoration of pelvic stability in a non-union scenario, rather than acute trauma management.
Common Pitfalls
- Billing R364 alongside other pelvic procedures without applying the 85% reduction rule for secondary procedures, which is a common trigger for audit recovery.
- Attempting to bill a standard hospital admission assessment on the same day as the procedure; remember that only the 'major pre-operative visit' is eligible for separate payment.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, as this is a mandatory requirement for OHIP validation.
Billing Tips
- Ensure the surgical report explicitly details the pseudoarthrosis to justify the use of R364 over more common musculoskeletal repair codes.
- If a second assistant is required for this complex reconstruction, you must obtain prior authorization from a medical consultant and include the surgeon's letter of justification with the claim submission.
Provider Fee$873.00
Surgical Assistant Fee$103.28
Anaesthetist Fee$159.60
Non-Anaesthetist Fee$159.60
Effective: April 1, 2026
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
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