R466 – Arthrodesis of elbow
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This fee code represents a surgical procedure on the musculoskeletal system. The fee is for the surgeon's professional service (suffix 'A').<br>As per the General Preamble, this service may be eligible for various premiums including age-based premiums for patients under 16 (), after-hours procedure premiums (E409, E410 on ), and the trauma premium (E420 on ).<br>Assistant and anaesthetist services are billed separately using this code with suffix 'B' and 'C' respectively, and their fees are calculated based on basic units and time units as described in the General Preamble (, ).
When to Use
- Use R466 for the definitive surgical fusion of the elbow joint, typically indicated for severe post-traumatic arthritis or failed total elbow arthroplasty.
- Use this code when performing a formal arthrodesis; do not use it for simple debridement or synovectomy procedures, which are billed under different musculoskeletal codes.
Common Pitfalls
- Billing R466 alongside other surgical procedures on the same joint without applying the Multiple Procedure Rule, which reduces the secondary procedure fee by 50%.
- Failure to document the specific Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, leading to automatic claim rejection during audits.
- Attempting to bill a consultation or office visit on the same day as R466; these are generally considered included in the global surgical fee unless a distinct, unrelated problem is addressed.
Billing Tips
- Ensure the referral source (Physician or Nurse Practitioner) is clearly documented, as R466 requires a valid referral to be eligible for payment.
- When billing for an assistant (suffix B) or anaesthetist (suffix C), ensure the base units and time units are calculated precisely according to GP85 and GP92 to avoid processing delays.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
As per , all insured services must be documented in appropriate records. The Act requires that the record 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.
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