R378 – LeFort III total maxillary advancement
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for a LeFort III total maxillary advancement. This is a Musculoskeletal System Surgical Procedure performed on the Skull and Mandible under the category of Orbito-Cranial Surgery. Note: The service includes the harvesting and grafting of bone or cartilage grafts as per the note on . Billing Information: - Surgeon (Suffix A): The fee for the surgeon is a flat rate. - Assistant (Suffix B): The fee is calculated using 12 base units plus time units. The time unit calculation is described in the General Preamble (). The unit value is multiplied by the Assistant Unit Fee (). - Anaesthetist (Suffix C): The fee is calculated using 25 base units plus time units. The time unit calculation is described in the General Preamble (). The unit value is multiplied by the Anaesthesiologist Unit Fee ().
When to Use
- Use R378 for complex craniofacial reconstruction involving total maxillary advancement where the procedure encompasses the full LeFort III osteotomy, distinguishing it from simpler LeFort I procedures like R653.
- Use R378 when the surgical plan necessitates the harvesting and grafting of autologous bone or cartilage, as these components are bundled into the R378 fee and cannot be billed separately.
Common Pitfalls
- Attempting to bill separate bone or cartilage harvesting codes (e.g., from the iliac crest or rib) is a common audit trigger, as these are explicitly included in the R378 global fee.
- Submitting a claim for a second surgical assistant without prior medical consultant authorization will result in automatic rejection, as R378 is not on the pre-approved list for multiple assistants.
- Failing to document the specific Injury Severity Score (ISS) in the medical record when attempting to apply the E420 trauma premium will lead to recovery of funds during a post-payment audit.
Billing Tips
- Ensure the operative report explicitly details the extent of the maxillary advancement and the specific sites of bone/cartilage harvest to support the R378 claim during potential chart reviews.
- When billing for the assistant (Suffix B) or anaesthetist (Suffix C), ensure the time units are calculated strictly according to the General Preamble (GP86/GP93) to avoid discrepancies between the surgeon's and assistant's reported procedure times.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
As this is a surgical procedure, an operative report is required.
The service includes harvesting and grafting of bone or cartilage grafts.
* Includes harvesting and grafting of bone or cartilage grafts.
Anaesthesia basic units: 25
Surgical Assistant basic units: 12
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