R509 – Patellar arthroplasty
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Patellar arthroplasty. This billing code represents a surgical procedure on the musculoskeletal system. The service is subject to general surgical billing rules, including the calculation of fees for assistants and anaesthetists based on basic and time units, and eligibility for various premiums such as after-hours and age-based add-ons.
When to Use
- Use R509 for isolated patellar arthroplasty when the procedure is limited to the patellofemoral joint.
- Use R509 when performing a patellar resurfacing as a standalone procedure, distinct from a total knee replacement.
Common Pitfalls
- Billing R509 in conjunction with a total knee arthroplasty (e.g., R990 or R993) is generally considered unbundling, as patellar resurfacing is typically included in the global fee for total knee replacement.
- Failure to document the specific surgical approach or the necessity of the patellar-only procedure can lead to audit rejections if the claim is flagged for review against global knee codes.
Billing Tips
- Ensure that the surgical report clearly distinguishes the patellar arthroplasty from any other concurrent knee procedures to avoid claims being rejected as inclusive of other major musculoskeletal codes.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
The medical 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.
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