R574 – Mallet finger - K-wire
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R574 is a surgical procedure listed in the Musculoskeletal System section of the Schedule of Benefits. The specific description for this service is not available in the provided context. A key payment rule for this service is that it is eligible for a second surgical assistant without requiring prior authorization from a medical consultant, as per .
When to Use
- Use R574 for the closed or open reduction and internal fixation of a distal interphalangeal (DIP) joint mallet finger injury using a K-wire.
- Select R574 when the clinical intent is to stabilize the terminal extensor tendon avulsion or fracture fragment specifically via percutaneous or open K-wire fixation.
Common Pitfalls
- Billing R574 alongside an evaluation and management code (like A007) for the same encounter is often rejected unless the assessment is for a distinct, unrelated problem.
- Failing to document the specific use of K-wire fixation can lead to audit recovery, as R574 is procedure-specific compared to more generic soft tissue repair codes.
- Attempting to bill R574 as a bilateral procedure without using the appropriate bilateral indicator or modifier can result in underpayment or rejection.
Billing Tips
- R574 is eligible for a second surgical assistant without prior authorization, making it a useful code to include when complex multi-planar stabilization requires additional support.
- Ensure the procedure start time is accurately recorded to maximize eligibility for after-hours premiums like E409 or E410 if the surgery is performed urgently outside of standard operating hours.
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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