R619 – Terminal Symes
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A Terminal Symes amputation (R619) is a surgical procedure involving the disarticulation of the foot at the ankle while preserving the heel pad. This service is categorized under musculoskeletal procedures for the foot and ankle. The amount payable to the surgeon is a set fee, while fees for the surgical assistant and anaesthesiologist are calculated based on basic and time units. This procedure is assigned 6 base units for anaesthesia (<suffix>C</suffix>) and 6 base units for a surgical assistant (<suffix>B</suffix>).
When to Use
- Use R619 specifically for a formal Symes amputation where the foot is disarticulated at the ankle joint and the heel pad is preserved for weight-bearing.
- Select R619 when the procedure is a definitive terminal amputation, distinguishing it from more proximal procedures like a below-knee amputation (e.g., R620) or partial foot amputations (e.g., R621, R622).
Common Pitfalls
- Do not bill R619 in conjunction with other foot amputation codes (e.g., R621 or R622) on the same limb, as this is considered an inclusive service; only the major procedure is eligible for the full base unit value.
- Avoid billing R619 as an add-on or secondary procedure; if performed bilaterally, ensure the appropriate bilateral billing rules are applied to avoid automatic rejection.
Billing Tips
- Ensure the surgical assistant and anaesthesiologist claims explicitly reference the 6 base units assigned to R619 to prevent manual processing delays.
- When performing R619 in an after-hours setting, ensure the start time of the procedure is documented to justify the application of E409 or E410 premiums.
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 to establish that: 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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