R442 – Replacement Liner
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Replacement Liner
When to Use
- Use R442 specifically for the isolated surgical replacement of a worn or damaged acetabular liner in a total hip arthroplasty.
- Use this code when the procedure is limited to the liner exchange and does not involve the removal or revision of the femoral or acetabular components.
Common Pitfalls
- Billing R442 alongside a more comprehensive revision code (e.g., R443 or R444) will result in a rejection for unbundling or duplicate service.
- Failing to document the specific clinical indication for the liner replacement, such as polyethylene wear or osteolysis, often leads to audit recovery.
Billing Tips
- Ensure the operative report clearly distinguishes the liner exchange from a full component revision to justify the use of this specific fee code over higher-valued revision codes.
Effective: April 1, 2026
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.
For anaesthesia services, time units are calculated based on the time the anaesthesiologist is in attendance with the patient in the OR. Each anaesthesiologist must indicate their starting and finishing times in the medical record.
For surgical assistant services, time is calculated from direct contact with the patient in the OR until the assistant is no longer required. For replacement assistants, start and stop times must be documented in the patient's permanent medical record.
When more than one assistant is required for a surgical procedure, and the service is not on the pre-approved list (R442 is not on this list), the second assistant's service is only eligible for payment following authorization by a medical consultant and requires submission of a letter from the surgeon outlining the reason the second assistant was required.
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