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R475
R475 – Ankle and subtalar fusion with or without additional midtarsal(s), one stage
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Pan-talar arthrodesis is a surgical procedure for the one-stage fusion of the tibiotalar, subtalar, and talonavicular joints of the ankle and foot.
When to Use
- Use R475 for a definitive pan-talar arthrodesis involving the fusion of the tibiotalar, subtalar, and talonavicular joints in a single operative session.
- Select R475 when performing a comprehensive reconstruction for severe post-traumatic arthritis or end-stage deformity that necessitates triple joint involvement.
Common Pitfalls
- Billing R475 in conjunction with R719 or R695 on the same patient, same side, and same day will result in an automatic rejection.
- Failure to document the specific joints fused can lead to audit scrutiny, as R475 is intended for the full pan-talar complex rather than isolated joint procedures.
- Attempting to bill individual fusion codes separately when a single-stage pan-talar procedure was performed is considered unbundling and is non-compliant.
Billing Tips
- Ensure the operative report clearly details the fusion of all three required joints (tibiotalar, subtalar, and talonavicular) to justify the use of the pan-talar code over lesser arthrodesis codes.
- If a second surgical assistant is required, you must obtain prior authorization from a medical consultant and include the surgeon's justification letter with the claim to avoid payment denial.
Provider Fee$1,250.20
Surgical Assistant Fee$77.46
Anaesthetist Fee$95.76
Non-Anaesthetist Fee$95.76
Effective: April 1, 2026
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
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