R400 – Repair chronic, recurrent elbow dislocation
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Repair of chronic, recurrent dislocation of the elbow joint. This is a surgical procedure listed in the Musculoskeletal System section of the Schedule of Benefits under the subheading for elbow and forearm reconstruction.
When to Use
- Use R400 for the definitive surgical repair of a patient with a history of recurrent elbow instability or chronic dislocation where conservative management has failed.
- Select R400 when performing reconstructive procedures specifically targeting the chronic, recurrent nature of the elbow dislocation, as opposed to acute reduction codes like D009 or D010.
Common Pitfalls
- Billing R400 for an acute, first-time dislocation is a common audit trigger; ensure the clinical record clearly substantiates the 'chronic' or 'recurrent' nature of the pathology.
- Do not bill R400 in conjunction with acute fracture reduction codes (e.g., D009) unless the procedure involves distinct, separate surgical sites or complex reconstruction beyond the scope of the reduction.
Billing Tips
- Always document the specific surgical technique used (e.g., ligamentous reconstruction or capsular repair) to support the 'reconstructive' classification of this code during potential reviews.
- If the procedure is performed on a trauma patient, ensure the Injury Severity Score (ISS) is documented in the chart to support the E420 trauma premium, as this is a high-intensity surgical intervention.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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