R613 – Amputation through radius and ulna
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R613 is a surgical procedure for amputation through the radius and ulna. Anaesthesia The anaesthesiologist's fee is calculated using 7 base units plus applicable time units as defined in the Schedule of Benefits (, ). Surgical Assistance The surgical assistant's fee is calculated using 6 base units plus applicable time units as defined in the Schedule of Benefits (, ). Second Assistant Payment for a second assistant for this procedure is not automatically insured and requires independent consideration. A letter from the surgeon outlining the necessity of a second assistant must be submitted for review, as R613 is not on the list of procedures for which a second assistant is pre-approved ().
When to Use
- Use R613 for formal amputation procedures performed through the radius and ulna, typically necessitated by severe trauma, malignancy, or non-reconstructible vascular disease.
- Select R613 over R614 (amputation through the humerus) when the surgical level is specifically distal to the elbow joint.
Common Pitfalls
- Attempting to bill for a second assistant without prior written authorization, as R613 is not on the pre-approved list under GP90.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, which is a mandatory requirement for patients meeting the age-specific ISS thresholds.
Billing Tips
- Ensure that if the procedure is performed on an urgent or emergent basis outside of standard hours, you append the appropriate E409 or E410 premium to the R613 base fee to maximize reimbursement.
- If a second assistant is medically necessary, submit the surgeon's letter of justification concurrently with the claim to avoid automatic rejection and facilitate the required medical consultant review.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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