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R533
R533 – Composite repair for facial paralysis, plication of paralyzed muscles, and resection for paralysis of over active muscles
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Composite repair for facial paralysis, plication of paralyzed muscles, and resection for paralysis of over active muscles. This service includes the necessary steps to restore function and appearance in cases of facial paralysis.
When to Use
- Use R533 when performing a comprehensive reconstruction involving both plication of paralyzed facial muscles and resection of overactive contralateral or ipsilateral muscles.
- Select R533 for complex facial reanimation procedures where multiple surgical techniques are combined into a single composite repair session.
Common Pitfalls
- Failing to include the Injury Severity Score (ISS) in the medical record will result in the automatic rejection of the E420 trauma premium.
- Submitting R533 without detailed operative notes often triggers a manual review by the Medical Consultant, which can delay payment processing.
- Attempting to bill R533 alongside other facial surgery codes without clear documentation of distinct, separate procedures may lead to claims being flagged for unbundling.
Billing Tips
- If performing a meloplasty concurrently, ensure the E597 add-on code is submitted on the same claim to capture the additional $87.05 fee.
- Always verify if the patient qualifies for age-based premiums (e.g., under 16 years) and append them to the R533 claim to maximize the procedural reimbursement.
Provider Fee$511.90
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
Claims for R533 will be assessed by the Medical Consultant.
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