R445 – Elbow - incision and drainage
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
As a surgical procedure within the Musculoskeletal System section, R445 includes all constituent and common elements of insured services. The fee for the surgeon (suffix A) covers the pre-operative, intra-operative, and post-operative care as defined in the Schedule of Benefits. Fees for surgical assistance (suffix B) and anaesthesia (suffix C) are calculated separately based on basic and time units.
When to Use
- Use R445 for the surgical incision and drainage of an elbow abscess or deep-seated infection requiring formal operative intervention.
- Use R445 when the procedure involves a formal surgical approach to the elbow joint or surrounding soft tissues for drainage, distinguishing it from simple office-based aspiration.
Common Pitfalls
- Billing R445 for simple office-based needle aspiration or superficial skin incision; these should be billed under minor procedural codes rather than the surgical R-series.
- Attempting to bill an additional office visit fee on the same day as R445, which is generally disallowed as the surgical fee includes pre-operative and post-operative care.
- Failing to document the specific anatomical site and the nature of the drainage, which can lead to audit rejections if the service is indistinguishable from a minor procedure.
Billing Tips
- Ensure that if the procedure is performed after hours or in an emergency setting, you append the appropriate E-series premium (e.g., E409 or E410) to the R445 claim to capture the full value of the service.
- If a surgical assistant is required, ensure the assistant's claim is linked to the R445 procedure code to ensure correct calculation of basic and time units.
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 the patient's medical record, establishing that the service was provided, is the service for which the account is submitted, and was medically necessary, as per .
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.