R500 – Removal - prosthesis without replacement
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R500 is a surgical procedure listed under the Musculoskeletal System section of the OHIP Schedule of Benefits. Payment is available for the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C). The surgeon's fee is a flat rate. The assistant's fee (suffix B) is calculated based on basic units (6) plus time units as described in -. The anaesthetist's fee (suffix C) is calculated based on basic units (6) plus time units as described in -. This service includes all common elements as defined in the General Preamble (-).
When to Use
- Use R500 for the definitive removal of a hardware prosthesis (e.g., metal plate, screw, or joint component) when no new device is being implanted during the same operative session.
- Select R500 when performing a secondary procedure to remove a failed or infected prosthesis where the site is being debrided and left without immediate replacement.
Common Pitfalls
- Billing R500 alongside a replacement procedure code; if a new prosthesis is inserted, the removal is typically considered an inclusive component of the replacement code, not a separate R500 claim.
- Failing to document the specific anatomical location or the nature of the removed hardware, which can lead to audit scrutiny regarding the necessity of the procedure.
Billing Tips
- Ensure that the surgical assistant (suffix B) and anaesthetist (suffix C) correctly calculate their time units based on the specific unit fee schedules (GP85-86 for assistants; GP92-93 for anaesthetists) rather than assuming a flat rate.
- If the removal is performed as a non-elective, emergency procedure outside of standard operating hours, ensure the appropriate after-hours or night premium (E409, E410, E400B/C, E401B/C) is appended to the claim to capture the correct procedural uplift.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
The fee payable for the surgical assistant service (suffix B) is based on 6 basic units plus time units.
The fee payable for the anaesthesia service (suffix C) is based on 6 basic units plus time units.
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