R467 – Shoulder arthrodesis
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Arthrodesis of the shoulder is a surgical procedure involving the artificial induction of joint ossification between two bones, in this case, within the shoulder joint. This procedure is typically performed to relieve intractable pain from conditions like severe arthritis, instability, or failed joint replacement, by permanently fusing the joint. The fee for the surgeon (suffix A) is a flat rate. The fee for an assistant (suffix B) is calculated based on 6 base units plus time units. The fee for an anaesthetist (suffix C) is calculated based on 6 base units plus time units. Refer to the Surgical Assistants' Services section (starting ) and Anaesthesiologists' Services section (starting ) of the Schedule for time unit calculations.
When to Use
- Use R467 for definitive surgical fusion of the glenohumeral joint in patients with end-stage arthritis or chronic instability where joint replacement is contraindicated or has failed.
- Select R467 when performing a salvage procedure for a failed shoulder arthroplasty, provided the intent is permanent joint immobilization.
Common Pitfalls
- Billing R467 alongside other shoulder procedures without checking for 'incidental' or 'inclusive' code rules, which can lead to automatic claim rejection.
- Failing to document the specific start and end times for the surgical assistant and anaesthetist, as these are required to calculate the time-based units beyond the 6 base units.
- Attempting to claim the E420 trauma premium without explicit documentation of the Injury Severity Score (ISS) in the patient record, which is a common audit trigger.
Billing Tips
- Ensure the surgical assistant and anaesthetist claims are submitted with the correct suffix (B or C) and include the base units plus the calculated time units as per the General Preamble.
- Verify that after-hours premiums (E400B/C or E401B/C) are applied only if the procedure start time meets the specific criteria defined in the Schedule, as these are not automatically calculated by the system.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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