R505 – Metatarsal/phalangeal
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R505 is a surgical procedure for an arthrotomy (surgical opening) of a metatarsal or phalangeal joint. The fee for the surgeon (suffix A) is a flat rate. Fees for an assistant (suffix B) and anaesthetist (suffix C) are calculated based on basic and time units, as detailed in the Schedule of Benefits. This service is subject to general rules for surgical procedures, including eligibility for age-based, after-hours, and trauma premiums.
When to Use
- Use R505 for an open arthrotomy of a metatarsal or phalangeal joint, such as for joint debridement or foreign body removal.
- Select R505 when the procedure involves a formal surgical opening of the joint capsule, distinguishing it from simple closed procedures or percutaneous interventions.
Common Pitfalls
- Do not bill R505 in conjunction with other procedures on the same joint during the same operative session, as the Schedule of Benefits dictates that only the major procedure is eligible for full payment.
- Avoid billing R505 for minor diagnostic procedures or simple aspirations that do not meet the criteria for a formal surgical arthrotomy.
Billing Tips
- Ensure that the operative report clearly documents the surgical opening of the joint capsule to support the use of an arthrotomy code over less invasive alternatives.
- When performing bilateral procedures, ensure the claim reflects the appropriate bilateral billing rules as per the General Preamble to avoid rejection.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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