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R434
R434 – Baker's cyst - extensive
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Extensive excision of a Baker's cyst. This procedure is performed for a fluid-filled sac (popliteal cyst) behind the knee that requires more comprehensive removal than a simple excision (R431). It is a surgical procedure listed under the Musculoskeletal System section and has assigned units for assistant and anaesthesia services.
When to Use
- Use R434 when the operative report clearly documents an extensive dissection or complex excision of a Baker's cyst that exceeds the scope of a simple excision (R431).
- Select R434 for cases involving the removal of a large, multiloculated cyst or one requiring significant neurovascular mobilization in the popliteal fossa.
Common Pitfalls
- Billing R434 for a simple aspiration or minor excision, which should be billed under R431 to avoid rejection or recovery during an audit.
- Failing to document the 'extensive' nature of the procedure, as the Ministry may downgrade the claim to R431 if the operative notes do not justify the higher complexity.
Billing Tips
- Ensure the operative report explicitly details the extent of the dissection to support the R434 fee over the lower-valued R431.
- When performing bilateral procedures during the same session, remember that anaesthesia and assistant basic units are only claimable for the major procedure.
Provider Fee$264.50
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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