R405 – Repeat closed reduction of congenital/developmental dislocation of the hip
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Repeat closed reduction of a congenital hip dislocation, which includes the application of a cast. This service is a subsequent procedure following an initial closed reduction, typically claimed under R404.
When to Use
- Use R405 for a subsequent closed reduction procedure on a congenital hip dislocation where the initial reduction (R404) has failed or requires revision.
- Apply this code when a repeat manipulation is required under anesthesia to achieve or maintain hip stability, provided the service includes the application of a new cast.
Common Pitfalls
- Claiming R405 for the initial reduction instead of R404, which will result in a rejection or audit discrepancy.
- Attempting to bill for cast application separately; the fee for R405 is inclusive of the cast, and additional cast codes are not payable.
- Failing to document the clinical necessity of the repeat procedure, which is essential to distinguish it from a routine follow-up visit.
Billing Tips
- Ensure the patient's age is accurately recorded to automatically trigger the appropriate age-based fee premium (e.g., AGE_PREMIUM_LT1Y or AGE_PREMIUM_LT2Y) to maximize the claim value.
- If an assistant is required for this procedure, you must claim M400B and provide a written justification to the Ministry, as assistant services are not automatically payable under R405.
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 that establish: 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.
Includes cast.
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