R414 – Synovectomy/capsulectomy/debridement - two or more joints
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Synovectomy/capsulectomy/debridement - two or more joints. As a surgical procedure, it includes pre-operative evaluation, the operation itself, and normal post-operative care. General rules for surgical procedures, including constituent and common elements as defined in the General Preamble of the Schedule of Benefits, apply. See pages - for details on constituent elements of insured services.
When to Use
- Use R414 when performing a synovectomy, capsulectomy, or debridement on two or more distinct joints during the same operative session.
- Select R414 for multi-joint procedures that do not have a more specific, higher-valued joint-specific code in the Schedule of Benefits.
Common Pitfalls
- Billing R414 for a single joint procedure is a common error; ensure the operative report explicitly confirms the involvement of at least two joints to avoid rejection.
- Attempting to bill R414 in addition to other joint-specific debridement codes for the same anatomical site often leads to claims being flagged for unbundling or duplicate billing.
- Failing to document the specific joints treated can lead to audit recovery, as the code definition strictly requires 'two or more' joints.
Billing Tips
- Ensure the operative report clearly details the pathology and the specific surgical intervention performed on each of the two or more joints to justify the use of this code.
- If performing R414 on an emergency basis, ensure the appropriate after-hours or trauma premiums are applied to the claim to maximize the procedural fee.
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 to 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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