R645 – Reconstruction mandible with bone grafts and/or plate or prosthesis - partial (Bilateral)
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs a bilateral partial reconstruction of the mandible. The procedure may involve the use of bone grafts, a plate, or a prosthesis as indicated. This service is designated as a major surgical procedure with defined base units for both surgical assistance (R645B) and anaesthesia (R645C). Payment for a second surgical assistant is eligible for this procedure without requiring special authorization from a medical consultant, as per :<PDFPageNumber>104</PDFPage-number>. The asterisk (*) next to 'bone grafts' in the Schedule of Benefits on page :<PDFPageNumber>595</PDFPage-number> suggests that bone graft harvesting may be separately billable.
When to Use
- Use R645 for bilateral partial mandibular reconstruction involving bone grafts, plates, or prostheses, distinguishing it from unilateral procedures like R646.
- Select this code when the clinical objective is the structural restoration of the mandible across both sides, regardless of whether the reconstruction is performed in a single stage or as part of a complex multi-disciplinary reconstruction.
Common Pitfalls
- Billing R645 alongside unilateral mandibular reconstruction codes (e.g., R646) is a common error; R645 is intended to capture the bilateral nature of the procedure, and duplicate billing for unilateral components will result in rejection.
- Failure to document the specific use of bone grafts or hardware (plates/prostheses) can lead to audit scrutiny, as the code definition explicitly relies on these components for clinical justification.
Billing Tips
- Since the Schedule of Benefits notes an asterisk (*) for bone grafts, ensure that if you harvest autologous bone grafts from a separate site, you bill the harvesting procedure as a separate service to maximize reimbursement.
- As this is a major surgical procedure, verify that your surgical assistant (R645B) and anaesthesiologist (R645C) are billing the correct corresponding base units, as these are fixed to the R645 procedure code.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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