R454 – Metatarsophalyngeal - multiple
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This surgical procedure involves the arthroplasty of multiple metatarsophalangeal joints, such as with a Swansons-type prosthesis. This fee code is for performing the procedure on more than one joint. The amount payable for the surgical assistant (suffix B) is based on 6 basic units plus time units. The amount payable for the anaesthetist (suffix C) is based on 7 basic units plus time units. Time unit calculations are governed by the rules in the General Preamble (, ).
When to Use
- Use R454 when performing arthroplasty on two or more metatarsophalangeal joints during the same operative session.
- Use this code for multi-joint procedures involving prosthetic implants, such as Swanson-type silastic implants, which are distinct from single-joint procedures like R453.
Common Pitfalls
- Billing R454 in conjunction with R453 for the same foot is a common error; R454 is intended to cover the multi-joint procedure, and adding R453 will result in a rejection for duplicate or overlapping service.
- Failure to document the specific number of joints addressed can lead to audit scrutiny, as R454 is specifically defined for multiple joints.
Billing Tips
- Ensure the surgical assistant and anaesthetist suffixes (B and C) are correctly applied to the base units specified in the Schedule of Benefits to avoid payment discrepancies.
- If the procedure is a revision of a previously performed arthroplasty, remember to append the E564 premium to the R454 claim to capture the 35% increase.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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