R653 – Bilateral periorbital correction Treacher-Collins Syndrome - with skull and muscle transpositions
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Bilateral periorbital correction for Treacher-Collins Syndrome with skull and muscle transpositions (intracranial). This service includes skull reconstruction. As per the note on , this procedure also includes the harvesting and grafting of bone or cartilage grafts. The service has 10 assistant (Asst) base units and 25 anaesthesia (Anae) base units.
When to Use
- Use R653 when performing comprehensive bilateral periorbital reconstruction specifically for Treacher-Collins Syndrome that necessitates both intracranial skull work and muscle transposition.
- Select R653 over general craniofacial reconstruction codes when the procedure explicitly involves the complex combination of skull reconstruction and muscle transposition required by the syndrome's specific anatomical deficits.
Common Pitfalls
- Attempting to bill separately for bone or cartilage harvesting/grafting is a common audit trigger, as these are explicitly included in the R653 fee.
- Billing R653 in conjunction with other reconstructive codes for the same anatomical site may lead to rejection for unbundling, as the code is designed to be comprehensive for the specified periorbital correction.
Billing Tips
- Ensure the operative report clearly details the intracranial component and the specific muscle transpositions performed to substantiate the use of this high-value code during a potential audit.
- Verify the patient's age at the time of the procedure and apply the appropriate age premium (e.g., AGE_PREMIUM_UNDER_16_YEARS) to the R653 base fee to ensure optimal reimbursement.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
In order to be eligible for payment, all insured services must be documented in the patient's medical record, establishing that the service was provided, the service claimed is the service rendered, and the service was medically necessary.
Includes harvesting and grafting of bone or cartilage grafts.
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