R469 – Sacro-iliac joint arthrodesis
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Arthrodesis of the sacro-iliac joint. This is a surgical procedure to fuse the sacroiliac joint, which connects the sacrum (the triangular bone at the base of the spine) to the ilium (the uppermost part of the hip bone). As a surgical procedure, payment includes all constituent and common elements of insured services as defined in the Schedule of Benefits on pages -.
When to Use
- Use R469 for the definitive surgical fusion of the sacro-iliac joint, distinct from diagnostic injections or non-surgical stabilization procedures.
- Select R469 when performing an open or percutaneous arthrodesis procedure specifically targeting the SI joint to address chronic sacroiliac joint dysfunction.
Common Pitfalls
- Billing R469 alongside other spinal fusion codes without ensuring the procedures are distinct and not considered inclusive components of the primary surgery.
- Failing to provide the required surgeon's letter of justification when billing for a second assistant, which leads to automatic rejection of the assistant's claim.
- Incorrectly applying trauma premiums (E420) without documenting the required Injury Severity Score (ISS) in the patient record, which is mandatory for this code.
Billing Tips
- Ensure the assistant fee is calculated based on the designated assistant unit value of 6, and verify that any applicable after-hours premiums (E400B/E401B) are applied to the assistant's total fee, not the base procedural fee.
- Always confirm that the anaesthesia units (7 base units) are supplemented by any eligible extra units (e.g., ASA status or BMI) to maximize the anaesthetic claim.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
When a second assistant is required, a letter from the surgeon outlining the reason is required for payment authorization by a medical consultant.
Asst: 6
Anae: 7
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