R573 – Mallet finger - open
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of lesion or tumour of muscle, subfascial or intermuscular, extensive, trunk or limbs. This fee is for the surgeon's professional service (suffix 'A'). Separate fees are listed for surgical assistant (suffix 'B') and anaesthetist (suffix 'C') services. As a surgical procedure, this service includes all constituent and common elements as defined in the Schedule of Benefits (see -).
When to Use
- Use R573 specifically for the open surgical repair of a mallet finger deformity requiring formal operative intervention.
- Select this code when the procedure involves the excision of a lesion or tumor located in the muscle or subfascial space of the digit, as defined by the code's scope.
Common Pitfalls
- Do not bill R573 for simple closed reductions or splinting of mallet fingers, as these are typically covered by visit or fracture management codes.
- Avoid billing R573 in conjunction with other minor surgical procedures on the same digit unless the requirements for multiple procedure billing are strictly met, as this often triggers audit flags for unbundling.
Billing Tips
- Ensure the operative report explicitly details the subfascial or intermuscular nature of the excision to justify the use of this specific code over more general musculoskeletal procedure codes.
- If the procedure is performed after hours for a non-elective indication, ensure the E409 or E410 premium is appended to the claim to capture the appropriate procedural uplift.
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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