R554 – Silicone rod insertion - one
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs the insertion of a silicone rod. This service is claimed with suffix 'A' by the operating surgeon. The fee includes pre-operative evaluation on the day of surgery and routine post-operative care. As a surgical procedure, services of a surgical assistant (claimed with suffix 'B') and an anaesthesiologist (claimed with suffix 'C') are separately billable as per the rules in the General Preamble. An additional silicone rod insertion can be billed with E051. When more than one assistant is required for this surgical procedure, the second assistant's service is only eligible for payment following authorization by a medical consultant and requires submission of a letter from the surgeon outlining the reason the second assistant was required, as R554 is not exempt from this requirement as per page of the Schedule.
When to Use
- Use R554 for the primary insertion of a single silicone rod in a musculoskeletal procedure.
- Use R554 in conjunction with E051 when multiple silicone rods are inserted during the same operative session.
Common Pitfalls
- Billing for a pre-operative assessment on the day of surgery as a separate visit code, as this is included in the R554 fee.
- Attempting to bill for a second surgical assistant without prior written authorization and a supporting letter from the surgeon, which will result in automatic rejection.
Billing Tips
- Ensure that any applicable age-based premiums (e.g., for patients under 16) are applied to the R554 fee to maximize reimbursement.
- If the procedure is performed after hours, ensure the correct after-hours premium (E409 or E410) is linked to the R554 claim to capture the 50% or 75% increase.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record 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.
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