R567 – LeFort I extrusion - in one segment
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
LeFort I extrusion, in one segment, is a surgical procedure categorized under Orthognathic Surgery. The fee for this procedure includes the harvesting and grafting of bone or cartilage grafts, as noted in the Schedule on page . As a surgical procedure, this service is eligible for various add-on premiums, including for additional segments (E965, E966), age-based premiums for patients under 16 (), after-hours procedure premiums for the surgeon (E409, E410), and the trauma premium (E420) if applicable (). Corresponding premiums also apply for surgical assistant and anaesthesia services when required.
When to Use
- Use R567 as the primary code for a single-segment LeFort I extrusion procedure, which inherently includes any necessary bone or cartilage grafting.
- Use R567 in conjunction with E965 when the LeFort I extrusion is performed across two distinct segments.
- Use R567 in conjunction with E966 when the LeFort I extrusion is performed across three distinct segments.
Common Pitfalls
- Do not bill for bone or cartilage harvesting separately, as the fee for R567 is inclusive of these components.
- Avoid claiming the trauma premium (E420) alongside after-hours premiums (E409, E410), as these are mutually exclusive under the Schedule.
- Ensure the number of segments is clearly identified, as failing to add E965 or E966 for multi-segment procedures results in significant under-billing.
Billing Tips
- Always verify the patient's age at the time of the procedure to ensure the appropriate age-based surgical premium (GP64) is applied to the R567 base fee.
- When performing multi-segment procedures, ensure E965 or E966 is submitted on the same claim as R567 to trigger the correct complexity payment.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
* Includes harvesting and grafting of bone or cartilage grafts.
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