R563 – Transplant/transfer - single
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
`R563` is a surgical procedure. The amount payable for the surgical assistant service is calculated by adding together the number of basic and time units and multiplying that total by the unit fee (see ). The amount payable for the anaesthesia service is calculated by adding the number of basic and time units and multiplying the total by the anaesthesiologist unit fee (see ). Payment for a second assistant is allowed without prior authorization from a medical consultant.
When to Use
- Use R563 for a single surgical transplant or transfer procedure when no other more specific musculoskeletal surgical code applies.
- Use this code for the primary surgical procedure when performing a single tissue transfer or transplant, ensuring it is not bundled into a more comprehensive procedure code.
Common Pitfalls
- Attempting to bill R563 alongside other musculoskeletal procedures that already include the transfer or transplant in their own fee description, leading to rejection for unbundling.
- Failing to identify the major procedure when multiple surgeries are performed; the basic units for the assistant and anaesthesiologist must be based solely on the major procedure, not the sum of all codes.
- Incorrectly assuming that a second surgical assistant requires prior authorization; R563 explicitly allows for a second assistant without consultant approval.
Billing Tips
- When billing for the surgical assistant or anaesthesiologist, ensure the basic units are derived strictly from the major procedure code to avoid audit flags.
- If the procedure qualifies as trauma, ensure the Injury Severity Score (ISS) is documented in the chart to support the E420 premium, as this is a common target for post-payment review.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Diagnostic and Therapeutic Procedures
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