R497 – Removal of total arthroplasty - without replacement
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R497 is a fee code for a surgical procedure within the Musculoskeletal System section. The service must be rendered personally by the physician. The fee for the surgeon (R497A) is a flat rate. The fees for an assistant (R497B) and anaesthesiologist (R497C) are calculated based on basic units plus time units. The basic units for the assistant for this procedure are 6, and for the anaesthetist are 6. Specific details of the procedure represented by this code were not available in the provided documentation.
When to Use
- Use R497 for the definitive removal of a total joint arthroplasty (e.g., hip or knee) where the intent is to leave the joint without a replacement prosthesis, such as in the case of a Girdlestone procedure for chronic infection.
- Use this code when the hardware is extracted due to failure or infection and no new prosthetic components are inserted during the same operative session.
Common Pitfalls
- Do not bill R497 if any component of a new arthroplasty is inserted; this would instead fall under revision arthroplasty codes like R441.
- Avoid billing R497 for simple hardware removal (e.g., screw or plate removal) which is covered under different musculoskeletal codes; R497 is specific to the removal of a total arthroplasty system.
- Failure to document the medical necessity for the 'no-replacement' approach can lead to audit scrutiny, as standard practice for failed arthroplasty is typically revision rather than excision.
Billing Tips
- Ensure the operative report explicitly states that the arthroplasty was removed and no replacement was performed to support the use of R497 over revision codes.
- When billing for the assistant (R497B) or anaesthesiologist (R497C), ensure the claim reflects the 6 basic units provided in the fee schedule to avoid automatic rejection or underpayment.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records. The record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
For services rendered by a Medical Trainee, the medical record must identify the Supervising Physician, the Medical Trainee and level of training, a description of the insured service, patient consent, and be signed off by the Supervising Physician. Refer to for full details.
Since the specific description for R497 was not provided in the source documents, this record is based on the General Preamble rules for surgical procedures and inferences from the master fee record. The basic units for assistant and anaesthetist services are 6, as specified on page .
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