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R472
R472 – Glenohumeral joint - open reduction, late
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving an incision to expose the glenohumeral joint to reduce a dislocation that is not treated acutely. This service is performed by a surgeon, typically with the assistance of another physician and an anaesthesiologist.
When to Use
- Use R472 for an open reduction of a glenohumeral dislocation that has persisted beyond the acute phase, typically requiring formal surgical exposure due to fibrous tissue formation or chronic instability.
- Select R472 when the procedure involves a formal arthrotomy or open approach to address a chronic, unreduced dislocation, as opposed to closed manipulation under anaesthesia (which would be billed under different codes).
- Use R472 when the clinical documentation explicitly supports a 'late' or 'chronic' reduction, distinguishing it from an acute, fresh dislocation managed via closed reduction.
Common Pitfalls
- Billing R472 in conjunction with R401 is prohibited; ensure you are not attempting to claim both for the same joint procedure as they are mutually exclusive.
- Failure to document the 'late' nature of the dislocation can lead to audit scrutiny, as the distinction between acute and late reduction is the primary clinical justification for the higher complexity of R472.
- Incorrectly applying trauma premiums (E420) when the procedure is elective or performed well beyond the 24-hour window of the initial injury.
Billing Tips
- Ensure the operative report clearly details the findings of chronic changes, such as capsular scarring or fibrous adhesions, to justify the 'late' classification of the reduction.
- When performing bilateral procedures or multiple musculoskeletal interventions during the same session, remember that anaesthesia and assistant units are restricted to the major procedure only.
Provider Fee$580.90
Surgical Assistant Fee$75.06
Anaesthetist Fee$154.90
Non-Anaesthetist Fee$154.90
Effective: April 1, 2025
Since Apr 2004, this fee has increased 0.0% vs 57.0% CPI inflation
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
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