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R599
R599 – Simple ligament reconstruction - one
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service covers the simple reconstruction of one ligament of the knee. It is distinct from R542 which is for extensive ligament reconstruction. This is a surgical procedure and is eligible for assistant and anaesthesia fees based on the listed base units.
When to Use
- Use R599 for isolated, simple ligament reconstruction of the knee, such as a primary repair or reconstruction of a single ligament.
- Select R599 when the procedure does not meet the complexity threshold of R542, which is reserved for extensive or multi-ligament reconstructions.
Common Pitfalls
- Billing R599 alongside R542 for the same knee is a common audit trigger; ensure the scope of the procedure matches the complexity defined by the specific code.
- Attempting to claim a second surgical assistant fee automatically will result in rejection, as R599 is not on the pre-approved list and requires prior authorization.
Billing Tips
- Always verify if the procedure qualifies for E420 trauma premiums by ensuring the Injury Severity Score (ISS) is documented in the chart, as this significantly impacts the total procedural reimbursement.
Provider Fee$361.95
Surgical Assistant Fee$75.06
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System Surgical Procedures
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