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R486
R486 – Complete arthroplasty replacement
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Complete arthroplasty replacement of the elbow joint. As a surgical procedure, it includes all common elements as defined in the and of the Schedule of Benefits.
When to Use
- Use R486 for the definitive total replacement of the elbow joint, typically indicated for end-stage rheumatoid arthritis or post-traumatic arthritis where joint destruction is severe.
- Select R486 when performing a primary total elbow arthroplasty; do not use for simple synovectomy or debridement procedures which are covered under other musculoskeletal codes.
Common Pitfalls
- Billing R486 alongside secondary procedures without verifying if the secondary procedure is considered 'included' in the global surgical fee as per GP13/GP14.
- Attempting to bill for a second surgical assistant without prior authorization; R486 is not on the pre-approved list, and claims will be rejected without a supporting letter and consultant review.
- Failure to document the Injury Severity Score (ISS) when attempting to apply the E420 Trauma Premium, leading to automatic rejection of the premium portion of the claim.
Billing Tips
- Ensure that the claim for the E420 Trauma Premium is submitted on the same claim as the R486 procedure to maintain eligibility.
- When performing R486 on an emergency basis after hours, ensure the start time is clearly recorded to justify the application of after-hours premiums like E409 or E410.
Provider Fee$1,205.95
Surgical Assistant Fee$77.46
Anaesthetist Fee$127.68
Non-Anaesthetist Fee$127.68
Effective: April 1, 2026
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
For the E420 Trauma Premium to apply, the medical record must list the Injury Severity Score (ISS).
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