R476 – Repair fascial defects - small
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs the repair of a small fascial defect as a reconstructive surgery on the elbow and forearm. The fee for the surgeon (suffix A) is a flat rate. The fee for the surgical assistant (suffix B) is calculated based on 6 basic units plus time units. The fee for the anaesthetist (suffix C) is calculated based on 7 basic units plus time units. This procedure is eligible for various after-hours, special visit, and other premiums. See - for detailed calculation rules for assistant and anaesthesia services.
When to Use
- Use R476 for the surgical repair of a small, localized fascial defect specifically located in the elbow or forearm region.
- Select R476 when the procedure is reconstructive in nature, distinguishing it from simple wound closures or debridement codes.
Common Pitfalls
- Billing R476 for larger or more complex fascial repairs that should be coded under R478, which is intended for larger defects.
- Failing to document the specific size and anatomical location of the fascial defect, which is critical for justifying the use of R476 over other musculoskeletal repair codes.
- Attempting to bill R476 in conjunction with other minor surgical procedures on the same site without clear documentation of separate, distinct incisions or pathology.
Billing Tips
- Ensure the surgical report explicitly describes the 'small' nature of the fascial defect to support the use of R476 and prevent audit reclassification to a more generic or higher-value code.
- When billing for the surgical assistant (suffix B) or anaesthetist (suffix C), remember that the age-based premiums for the surgeon (suffix A) also apply to the assistant's fee, but anaesthesia units are calculated separately using the specific E-series codes provided in the Schedule of Benefits.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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