R396 – Construction absent condyle and ascending ramus
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Construction of an absent condyle and ascending ramus. A note on page specifies that this service includes harvesting and grafting of bone or cartilage grafts.
When to Use
- Use R396 for the definitive surgical reconstruction of a congenital or acquired absence of the mandibular condyle and ascending ramus.
- Select this code when the procedure involves the comprehensive restoration of the ramus structure, distinguishing it from simpler procedures like R389 (condylectomy) or R395 (resection of mandible).
Common Pitfalls
- Attempting to bill separately for bone or cartilage harvesting; the Schedule of Benefits explicitly includes these components within the R396 fee.
- Failing to document the specific graft source or the structural reconstruction of the ramus, which is required to justify the R396 fee over less complex mandibular procedures.
Billing Tips
- Ensure the operative report clearly details the reconstruction of both the condyle and the ascending ramus to support the R396 claim against potential audit inquiries.
- If the patient is under 16, remember to apply the appropriate age-based surgical premium to the R396 base fee.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Operative report must document the construction of the absent condyle and ascending ramus. As this service includes harvesting and grafting of bone or cartilage, this should also be documented if performed.
* Includes harvesting and grafting of bone or cartilage grafts.
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