R506 – Prepatellar bursae
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R506 is a fee code for a surgical procedure related to the musculoskeletal system. The fee is payable to the surgeon (suffix A), surgical assistant (suffix B), and anaesthesiologist (suffix C), with amounts calculated based on basic and time units as outlined in the Schedule of Benefits. General payment rules for surgical procedures, including after-hours premiums, special visit premiums, and age-based premiums, apply.
When to Use
- Use R506 for the definitive surgical excision or drainage of a prepatellar bursa when the procedure is performed in an operating room setting.
- Select R506 when the clinical documentation confirms a formal surgical intervention, distinguishing it from simple office-based aspiration which would be billed as a minor procedure or visit code.
Common Pitfalls
- Billing R506 alongside a consultation or assessment code on the same day is a common rejection; ensure the surgical procedure is the primary service and the assessment is only billed if it is a separate, identifiable service with a diagnostic code.
- Failing to document the specific surgical approach or the necessity of the procedure can lead to audit recovery, as R506 is a specific procedural code that assumes a formal surgical event.
Billing Tips
- If the procedure is performed on an emergency basis, ensure you append the appropriate non-elective premium (E409A or E410A) to the claim to capture the 50% or 75% increase, as these are not automatically applied.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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