R556 – Tenolysis - single
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R556 is a surgical procedure for tenolysis - single. Payment is available for the surgeon (suffix A), assistant (suffix B), and anaesthesiologist (suffix C). The fees for assistant and anaesthesiologist are calculated based on basic units and time units. Various premiums may apply, including age-based premiums, after-hours premiums, and the trauma premium.
When to Use
- Use R556 for the surgical release of a single tendon from restrictive adhesions when no other major procedure is performed on that specific tendon.
- Use R556 when performing a secondary procedure to free a tendon that has become tethered following a previous tendon repair or trauma.
Common Pitfalls
- Billing R556 in addition to a primary tendon repair code (e.g., R555) is generally considered inclusive; ensure the tenolysis is a distinct, separate procedure to avoid rejection for unbundling.
- Failure to document the specific tendon involved and the nature of the adhesions can lead to audit recovery, as R556 is a single-site procedure.
Billing Tips
- If performing tenolysis on multiple tendons during the same operative session, verify if the Schedule of Benefits allows for a multiple procedure reduction or if a different code is required for multiple sites.
- Ensure that if R556 is performed as part of a larger musculoskeletal reconstruction, you are not inadvertently billing a component of a more comprehensive surgical code.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Digestive 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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