R522 – Muscle - simple
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
- simple
When to Use
- Use R522 for the simple excision of a localized muscle lesion or biopsy where the procedure does not meet the complexity criteria for more extensive musculoskeletal surgical codes.
- Select R522 when performing a minor surgical release or simple muscle repair that is distinct from tendon repair codes (e.g., R990) or more complex reconstructive procedures.
Common Pitfalls
- Billing R522 alongside a consultation or assessment fee on the same day is a common rejection; ensure the visit is only claimed if it qualifies as the 'major pre-operative visit' where the decision to operate was finalized.
- Attempting to bill R522 as an add-on to other major musculoskeletal surgeries often results in 'incidental procedure' denials, as it is generally considered inclusive of the primary surgical approach.
Billing Tips
- Ensure the operative report clearly describes the 'simple' nature of the muscle procedure to justify the use of R522 over more complex musculoskeletal codes that carry higher fees.
- If performing R522 after hours, ensure the claim includes the appropriate E-code premium (E409 or E410) and that the start time is clearly documented in the surgical record to support the non-elective or emergency status.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Spinal Surgical Procedures
All insured services must be documented in appropriate records that establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
Unit-based calculations for time apply to anaesthetist (suffix C) and surgical assistant (suffix B) services. The surgeon's fee (suffix A) is a flat fee. See the Surgical Assistants' Services () and Anaesthesiologists' Services () sections of the General Preamble for details on unit calculation.
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