R615 – High humerus
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the amputation of the high humerus. This service is performed under the Musculoskeletal System Surgical Procedures category. The fee for this service includes all common and specific elements applicable to surgical procedures as outlined in the OHIP Schedule of Benefits. Payment for assistant and anaesthesia services are calculated based on a unit system. The assistant's fee is calculated using 6 base units plus time units. The anaesthesiologist's fee is calculated using 6 base units plus time units.
When to Use
- Use R615 specifically for a high humerus amputation; do not use this code for lower-level arm amputations which may fall under R616 or R617.
- Apply this code for surgical procedures involving the proximal humerus where the amputation level is classified as high, distinguishing it from mid-shaft or distal procedures.
Common Pitfalls
- Billing R615 in conjunction with other musculoskeletal procedures on the same limb without clear documentation of separate incisions or distinct procedures may trigger a rejection for unbundling.
- Failure to document the specific level of amputation can lead to audit scrutiny if the procedure performed does not clinically align with the 'high humerus' definition of R615.
- Incorrectly applying age-based premiums (e.g., AGE_PREMIUM_5_TO_16_YEARS) without verifying the patient's exact age at the time of the procedure often results in automatic claim adjustment.
Billing Tips
- Ensure that the surgical assistant and anaesthesiologist units are calculated based on the 6 base units plus time, and verify that any applicable after-hours premiums (E400B/C or E401B/C) are submitted on the same claim.
- When performing this procedure as an emergency, ensure the non-elective status is clearly indicated to support the use of after-hours procedure premiums like E409 or E410.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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