R485 – Total radio-carpal arthroplasty
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Total wrist arthroplasty involves the surgical replacement of the wrist joint. This service is listed in the Schedule of Benefits under the Musculoskeletal System section and is intended for the hand and wrist. The service is eligible for surgeon (<suffix>A</suffix>), assistant (<suffix>B</suffix>), and anaesthetist (<suffix>C</suffix>) fees. Fees for assistant and anaesthetist services are calculated based on a combination of base units and time units. Additional premiums may apply for factors such as patient age, after-hours service, or if the procedure is a revision of a previous arthroplasty using E564.
When to Use
- Use R485 for the primary surgical replacement of the radio-carpal joint due to advanced degenerative or inflammatory arthritis.
- Use R485 in conjunction with E564 when performing a revision of a previously failed total wrist arthroplasty.
Common Pitfalls
- Billing R485 alongside R285 or R316 is prohibited as these are mutually exclusive procedures for the same anatomical site.
- Failing to append the E564 modifier when performing a revision procedure results in a significant underpayment of the 35% premium.
Billing Tips
- Ensure the operative report clearly details the components replaced to justify the use of R485 over other musculoskeletal codes.
- Always verify if the procedure qualifies for after-hours premiums (E409 or E410) based on the exact start time of the surgery to maximize the claim value.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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