R468 – Knee
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Knee
When to Use
- Use R468 for general knee surgical procedures that do not fall under specific arthroplasty codes like R441 (total knee replacement) or R442 (revision).
- Select this code for non-specific knee musculoskeletal interventions where no other more descriptive surgical code exists in the Schedule of Benefits.
Common Pitfalls
- Billing R468 for a total knee replacement is an error; use R441 for total knee replacement or R442 for revisions to avoid claim rejection.
- Attempting to bill a hospital admission assessment alongside R468 will result in a rejection, as it is considered included unless it qualifies as the 'major pre-operative visit'.
Billing Tips
- If the procedure is performed after hours, ensure you append the appropriate premium (E409 or E410) to the R468 claim rather than billing it as a separate service.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
The medical record must establish that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary, as per the Act.
For anaesthesia extra units, the medical record must document the specific condition justifying the extra units (e.g., ASA level, BMI, position, age).
If a second assistant is used, a letter from the surgeon outlining the reason the second assistant was required must be submitted for authorization.
For trauma premium (E420), the medical record must list the Injury Severity Score (ISS).
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