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R498
R498 – Removal prosthesis/no replacement
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is a surgical procedure for the arthroplasty of the shoulder, specifically for the removal of a prosthesis without replacement. The fee is for the surgeon's service (suffix A). Separate fees and calculations apply for assistant (suffix B) and anaesthesia (suffix C) services based on basic and time units.
When to Use
- Use R498 for the definitive removal of a failed, infected, or painful shoulder prosthesis when no immediate replacement or revision arthroplasty is performed.
- Use this code for a Girdlestone-type procedure of the shoulder where the implant is excised and the joint is left as a pseudoarthrosis.
Common Pitfalls
- Billing R498 in conjunction with a revision arthroplasty code (e.g., R438) is a common error; R498 is strictly for removal without replacement.
- Failing to document the clinical necessity for leaving the joint without a prosthesis, which is often audited to ensure it was not an incomplete revision procedure.
Billing Tips
- Ensure the operative report explicitly states that no replacement prosthesis was inserted, as this is the primary differentiator from revision codes like R438.
- If the removal is performed due to deep infection, ensure the diagnosis code reflects the underlying pathology, as this supports the medical necessity of the excision.
Provider Fee$397.20
Surgical Assistant Fee$75.06
Anaesthetist Fee$123.92
Non-Anaesthetist Fee$123.92
Effective: April 1, 2025
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
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