R587 – Quadriceps repair - reconstructive
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Quadriceps repair - reconstructive. As an insured service, it includes all common elements outlined in - of the Schedule. The service involves the performance of the surgical procedure itself, including preparation of the patient, and immediate post-operative care until the first post-operative visit. The fee typically includes the pre-operative consultation or assessment at which the decision to operate is made.
When to Use
- Use R587 for the definitive surgical repair of a complete quadriceps tendon rupture requiring reconstruction.
- Use R587 when the procedure involves significant tissue mobilization or graft augmentation to restore the extensor mechanism, distinguishing it from simple primary repair.
Common Pitfalls
- Billing R587 alongside a consultation fee for the same patient on the same day is a common error, as the fee includes the pre-operative decision-making visit.
- Failure to append the correct suffix (A for surgeon, B for assistant, C for anaesthetist) will result in an immediate rejection of the claim.
- Attempting to bill R587 in addition to minor soft tissue debridement codes is often flagged during audits as unbundling, as the repair fee covers the comprehensive surgical procedure.
Billing Tips
- If the procedure is performed as a non-elective surgery due to acute trauma, ensure the operative report clearly justifies the urgency to support the application of after-hours premiums like E409 or E410.
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 that establish: an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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