R542 – Extensive ligament reconstruction of knee
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R542 is a surgical procedure for extensive reconstruction of knee ligaments. The service includes, when rendered, the preparation of the intracondylar notch and may involve the use of synthetic materials. This procedure is billable by the surgeon (suffix A), an assistant (suffix B), and an anaesthetist (suffix C). - Assistant Fee (`B` suffix): Calculated based on 6 base units plus time units as described in -. - Anaesthesia Fee (`C` suffix): Calculated based on 7 base units plus time units as described in -.
When to Use
- Use R542 for primary or secondary extensive reconstruction of knee ligaments where the procedure involves significant structural repair or replacement.
- Use R542 when the surgical scope exceeds simple arthroscopic debridement or minor ligament repair, specifically involving the preparation of the intracondylar notch.
Common Pitfalls
- Failing to append the E059 premium when performing a revision or repair on a knee that has undergone a previous ligament reconstruction, resulting in a 30% underpayment.
- Incorrectly billing R542 for minor ligament procedures that do not meet the criteria for 'extensive' reconstruction, which risks audit recovery.
Billing Tips
- Always verify if the patient has a history of prior knee ligament reconstruction to ensure the E059 30% premium is applied to the R542 base fee.
- Ensure the surgical report explicitly documents the preparation of the intracondylar notch and the use of materials to support the 'extensive' classification of the procedure.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Payable to the surgeon (suffix A).
An assistant's service (suffix B) is payable based on 6 basic units plus time units. See for calculation details.
An anaesthesiologist's service (suffix C) is payable based on 7 basic units plus time units. See for calculation details.
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