R406 – Open reduction of congenital/developmental dislocation of the hip
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Open reduction for a congenital hip dislocation. The service includes performing a tenotomy and arthrotomy. The fee for the surgeon is a flat rate, while fees for an assistant and anaesthetist are calculated based on base units plus time units.
- Surgeon (A Suffix): Flat fee.
- Assistant (B Suffix): 7 base units plus time units. (Source: ).
- Anaesthetist (C Suffix): 7 base units plus time units. (Source: ).
When to Use
- Use R406 for the definitive open reduction of a congenital or developmental hip dislocation, which explicitly includes the necessary arthrotomy and tenotomy.
- Select R406 when the procedure involves open surgical access to the hip joint for reduction, distinguishing it from closed reduction procedures (e.g., Z291) or simple soft tissue releases.
Common Pitfalls
- Do not bill for a second surgical assistant automatically; R406 is not on the pre-approved list, and any claim for a second assistant will be rejected without prior independent medical consultant review.
- Avoid unbundling the tenotomy or arthrotomy; these components are inclusive to R406 and cannot be billed as separate surgical procedures.
Billing Tips
- Ensure the appropriate age-based surgical premium is applied to the R406 flat fee, as these are mandatory adjustments based on the patient's age at the time of service.
- When billing for surgical assistants or anaesthetists, ensure the base units (7) are correctly combined with the documented time units to avoid processing delays.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Includes tenotomy and arthrotomy.
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