R526 – Sternomastoid release
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the release of the sternomastoid muscle. Payment is structured based on the role of the physician: - Surgeon (suffix A): The listed fee is for the primary surgeon performing the procedure. - Assistant (suffix B): The fee is calculated based on 6 base units plus time units as per the rules on -. - Anaesthetist (suffix C): The fee is calculated based on 7 base units plus time units as per the rules on -.
When to Use
- Use R526 for the surgical release of a contracted sternomastoid muscle, typically in the management of congenital muscular torticollis.
- Use this code for definitive surgical intervention when conservative physiotherapy management has failed to resolve the muscle contracture.
Common Pitfalls
- Billing R526 alongside other musculoskeletal procedures without verifying if the procedure is considered inclusive under the Schedule of Benefits, which may lead to claim rejection for unbundling.
- Failing to document the specific surgical approach or the necessity of the release, which is required to justify the procedure during a post-payment audit.
- Incorrectly applying age-based premiums; ensure the patient's age at the time of the procedure strictly aligns with the specific percentage increase categories defined in the Schedule.
Billing Tips
- Always append the correct suffix (A for surgeon, B for assistant, C for anaesthetist) to ensure the claim is processed against the correct fee structure and unit calculations.
- If the procedure is performed on an emergency basis, ensure the non-elective premium (E409A or E410A) is submitted on the same claim to capture the 50% or 75% increase respectively.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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