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R564
R564 – Tenotomy - open - one
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
When to Use
- Use R564 for a single open tenotomy procedure on the knee when no other tendons are released during the same surgical session.
- Use R564 when performing a primary open tenotomy; if the procedure is part of a more extensive reconstruction, ensure the documentation clearly isolates the tenotomy as a distinct surgical event.
Common Pitfalls
- Do not bill R564 alongside R566; if multiple tendons are released, R566 is the required code to avoid claim rejection for duplicate or incorrect procedural billing.
- Avoid billing a separate hospital admission assessment or routine follow-up visit, as these are considered included in the global surgical fee associated with R564.
Billing Tips
- Ensure the operative report explicitly states that a single tendon was released to justify the use of R564 over the multiple-tendon code R566.
- If the procedure is performed after hours or for trauma, verify that you are applying the correct premium (e.g., E409 or E420) to the base fee of $232.00, ensuring all documentation requirements for those specific premiums are met.
Provider Fee$232.00
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
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