R372 – Pseudoarthrosis - Congenital pseudoarthrosis
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Represents a surgical arthrotomy of the hip, with or without synovectomy. As an insured service, this procedure includes all common and specific elements outlined in the Schedule of Benefits. Common Elements (as per -14): - Follow-up care arrangements - Appointment scheduling - Travel to the location of service - History taking and review of information - Obtaining consent - Record keeping - Providing medical prescriptions - Preparing documents for MOH programs - Conferring with other professionals - Planning, preparation, and administration - Provision of premises and supplies (unless otherwise specified) Surgical Service Elements: For the Surgeon (R372A): In addition to common elements, this includes the pre-operative assessment where the decision to operate is made, performing the surgery, and providing normal post-operative care. For the Surgical Assistant (R372B): Includes preparing the patient, assisting the surgeon during the procedure, assisting with recovery room transfer, and post-procedure monitoring until the first post-operative visit (see ). For the Anaesthetist (R372C): Includes pre-anaesthetic evaluation, administration and management of anaesthesia, and post-anaesthetic follow-up (see ).
When to Use
- Use R372A when performing a surgical arthrotomy of the hip specifically for the management of congenital pseudoarthrosis.
- Select this code when the procedure involves a synovectomy of the hip joint in conjunction with the arthrotomy.
Common Pitfalls
- Attempting to bill a second surgical assistant without prior authorization, as R372 is not pre-approved for secondary assistance.
- Failing to include the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium, which leads to automatic rejection.
- Billing R372 in conjunction with other hip procedures that are considered inclusive under the Schedule of Benefits, leading to duplicate billing flags.
Billing Tips
- Ensure that if the procedure is performed for a trauma patient within 24 hours, the ISS is clearly documented to support the E420 premium claim.
- Always verify if the E041 add-on code is applicable to your specific surgical approach, as it provides an additional flat fee for specific hardware fixation.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
When claiming the trauma premium (E420), the medical record must list the Injury Severity Score (ISS).
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