R456 – Metatarsophalyngeal interposition - single
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical procedure for a single metatarsophalangeal interposition arthroplasty. This service is for a single joint; for each additional joint, use billing code E538. This service is eligible for suffixes A (Surgeon), B (Assistant), and C (Anaesthetist). The assistant service (R456B) is assigned 6 basic units. The anaesthesia service (R456C) is assigned 6 basic units.
When to Use
- Use R456 for the primary metatarsophalangeal interposition arthroplasty on a single joint.
- Use R456 in combination with E538 when performing the same procedure on multiple joints during the same operative session.
Common Pitfalls
- Billing R456 multiple times for multiple joints instead of using the required E538 add-on code for subsequent joints.
- Failing to document the Injury Severity Score (ISS) in the medical record when claiming the trauma premium E420.
Billing Tips
- Ensure the primary procedure is billed as R456 and all subsequent joints are billed as E538 to avoid claim rejection or audit flags.
- Verify that the surgical assistant (R456B) and anaesthetist (R456C) services are billed with the correct suffix to ensure the 6 basic units are applied correctly.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
If claiming the trauma premium (E420), the medical record must list the Injury Severity Score (ISS).
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