R403 – Repair of recurrent dislocation, with or without osteotomy
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R403 represents a surgical procedure within the urogenital system. The fee paid to the surgeon is a flat rate. Fees for surgical assistants and anaesthetists are calculated based on a combination of basic units and time units, as detailed in the General Preamble of the Schedule of Benefits. Various premiums, such as those for after-hours service, age, and trauma, may also be applicable.
When to Use
- Use R403 for the surgical repair of a recurrent joint dislocation, specifically when the procedure includes an associated osteotomy.
- Select R403 when performing a revision surgery for a previously failed stabilization procedure where recurrent instability is the primary indication.
Common Pitfalls
- Billing R403 in conjunction with other stabilization codes for the same joint during the same operative session, which triggers a duplicate service rejection.
- Failing to document the specific 'recurrent' nature of the dislocation in the operative report, which is a mandatory requirement to justify the use of this specific code over primary repair codes.
- Attempting to claim the E420 trauma premium without explicit documentation of an Injury Severity Score (ISS) greater than 15 (for adults) or 12 (for pediatrics) in the medical record.
Billing Tips
- Ensure the operative report clearly describes the osteotomy component if performed, as this justifies the complexity inherent in the R403 fee structure.
- If the procedure is performed after hours, verify the start time of the surgery to correctly apply either E409 (evenings) or E410 (nights) to maximize the procedural fee.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
The medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
An appropriate operative report is required.
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