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R428
R428 – Temporomandibular meniscectomy
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Temporomandibular meniscectomy is the surgical removal of the cartilage disc (meniscus) from the temporomandibular joint. This procedure is billable by the surgeon (suffix A), and also allows for billing by a surgical assistant (suffix B) with 6 basic units, and an anaesthesiologist (suffix C) with 7 basic units.
When to Use
- Use R428 for the definitive surgical excision of the temporomandibular joint meniscus in cases of internal derangement refractory to conservative management.
- Select R428 when performing an open arthrotomy specifically for meniscectomy, distinguishing it from arthroscopic procedures which may fall under different procedural codes.
Common Pitfalls
- Billing R428 alongside other TMJ surgical procedures without verifying if the secondary procedure is considered inclusive or requires a manual review for multiple procedure rules.
- Failing to document the specific surgical approach or the necessity of the meniscectomy, which can lead to recovery of funds during a post-payment audit.
Billing Tips
- Ensure the surgical assistant (suffix B) and anaesthesiologist (suffix C) utilize the correct base units (6 and 7 respectively) to avoid automatic rejection of the claim.
- Apply age-based premiums (e.g., for patients under 16) or trauma premiums (E420) if the clinical criteria for the Injury Severity Score are met and documented in the chart.
Provider Fee$249.75
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
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