R514 – Symphysis pubis
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Arthrodesis of the symphysis pubis. This is a surgical procedure to fuse the joint between the pubic bones. As a surgical service, this fee includes all constituent and common elements as defined in the Schedule of Benefits. The surgeon's fee (suffix A) includes the major pre-operative visit, the operation itself, and normal post-operative care. Assistant (Suffix B): The assistant's service includes preparation of the patient, assisting in the procedure, and post-operative monitoring as defined on . Anaesthetist (Suffix C): The anaesthetist's service includes a pre-anaesthetic evaluation, the anaesthetic procedure, and post-anaesthetic follow-up as defined on .
When to Use
- Use R514 for the definitive surgical fusion of the symphysis pubis joint, typically indicated for chronic symphyseal instability or non-union following trauma.
- Use this code when performing an arthrodesis procedure that involves stabilization of the pubic symphysis, distinguishing it from simple debridement or soft tissue repair codes.
Common Pitfalls
- Do not bill R514 in conjunction with other pelvic fracture fixation codes (e.g., R469 or R470) unless the procedures are distinct and performed through separate incisions, as the Ministry may view this as unbundling.
- Avoid billing R514 for diagnostic procedures or simple joint injections, as this code is strictly for the surgical arthrodesis procedure.
Billing Tips
- Ensure that the surgical report clearly describes the fusion technique used, as this is the primary documentation required to justify the arthrodesis fee over lesser surgical interventions.
- When billing for the assistant (suffix B) or anaesthetist (suffix C), ensure time units are calculated precisely according to the 15-minute increment rules defined in GP85 and GP92 to avoid automatic claim adjustments.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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