R487 – Total prosthesis
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical arthroplasty procedure involving the replacement of the shoulder joint with a total prosthesis. This procedure is eligible for surgeon (A), assistant (B), and anaesthetist (C) fees. Payment for assistant and anaesthesia services is calculated based on basic and time units. A second assistant's service is payable without prior authorization. This procedure is also eligible for various add-on premiums, including for revision (E564), patient age, trauma, and after-hours services.
When to Use
- Use R487 when performing a complete replacement of the glenohumeral joint with a total prosthesis, distinguishing it from hemiarthroplasty procedures like R438.
- Apply R487 for primary total shoulder arthroplasty cases; if replacing a previously failed prosthesis, you must append E564 to the claim.
- Use R487 for complex shoulder reconstructions requiring both humeral and glenoid components, ensuring the documentation reflects the total nature of the implant.
Common Pitfalls
- Failing to append E564 when performing a revision of a previously placed total shoulder prosthesis, which results in underpayment of the 35% premium.
- Attempting to bill the E420 trauma premium alongside after-hours premiums; these are mutually exclusive and the claim will be rejected if both are submitted.
- Incorrectly coding a hemiarthroplasty (R438) as a total prosthesis (R487), which constitutes a billing error and potential audit risk.
Billing Tips
- Always ensure the Injury Severity Score (ISS) is explicitly documented in the operative report if claiming the E420 trauma premium to satisfy audit requirements.
- When a second assistant is utilized, bill the second assistant's service on the same claim as R487 to ensure automatic processing without the need for manual prior authorization.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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