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R596
R596 – Acromio-clavicular/sterno-clavicular - late
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical procedure for a late open reduction of the shoulder, arm, or chest. This procedure is indicated when treatment is delayed beyond the acute phase of the injury. It is listed with 6 basic units for assistant services and 6 basic units for anaesthesia services.
When to Use
- Use R596 for delayed open reduction procedures of the acromio-clavicular or sterno-clavicular joints where the injury is no longer in the acute phase.
- Select this code when performing reconstructive or stabilization surgery for chronic instability or non-union following a failed initial conservative management of a clavicular joint injury.
Common Pitfalls
- Billing R596 for acute injuries; acute reductions must be billed under the appropriate acute-phase surgical codes to avoid rejection for incorrect clinical context.
- Failing to document the 'late' nature of the procedure in the operative report, which is essential for justifying the use of this specific code over acute-phase alternatives.
- Attempting to stack E420 trauma premiums with after-hours premiums (E409/E410); these are mutually exclusive and the system will reject the claim if both are applied.
Billing Tips
- Ensure the operative report explicitly details the chronic pathology or delayed presentation to support the 'late' classification required for R596.
- Verify the patient's age at the time of the procedure to automatically apply the correct age-based premium, as these are not automatically calculated by the system without proper coding.
Provider Fee$350.50
Surgical Assistant Fee$77.46
Anaesthetist Fee$95.76
Non-Anaesthetist Fee$95.76
Effective: April 1, 2026
Since Oct 2005, this fee has increased 22.3% vs 52.9% CPI inflation
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
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