R658A – LeFort II, subcranial hypertelorism correction Le Fort I maxillary advancement
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs a LeFort II, subcranial hypertelorism correction and LeFort I maxillary advancement. This is a major craniofacial reconstructive surgery. The service is comprehensive and includes the harvesting and grafting of bone or cartilage grafts when required, as per the note on page of the Schedule. The fee for the surgeon (R658A) is a set procedural fee. The fee for the surgical assistant (R658B) is based on 12 base units plus time units. The fee for the anaesthesiologist (R658C) is based on 25 base units plus time units. The calculation of time units for both assistant and anaesthesiologist roles is detailed in the General Preamble (, ).
When to Use
- Use R658 when performing a combined LeFort II osteotomy with subcranial hypertelorism correction and LeFort I maxillary advancement in a single surgical session.
- Select this code for complex craniofacial reconstruction where bone or cartilage grafting is required, as these components are bundled into the R658 fee.
Common Pitfalls
- Attempting to bill bone or cartilage harvesting separately is a common error; these are explicitly included in the R658 fee and will be rejected if claimed as additional procedures.
- Failing to document precise start and end times for the surgical assistant and anaesthesiologist will lead to audit risks, as their compensation is strictly tied to time units per GP86 and GP93.
- Billing a second surgical assistant without prior medical consultant authorization is a frequent cause of rejection, as R658 is not on the pre-approved list for multiple assistants.
Billing Tips
- Ensure the surgical report explicitly details the complexity of the hypertelorism correction and the advancement to justify the comprehensive nature of the R658 procedure.
- If the patient is 65 years of age or older, remember to apply the 15% age-based premium to the R658 procedural fee to maximize your claim.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
For surgical assistant services, time spent must be documented in the medical record for time unit calculation. ()
For anaesthesiologist services, anaesthesia time must be documented in the medical record for time unit calculation. ()
If the Trauma Premium (E420) is claimed, the medical record must list the Injury Severity Score (ISS). ()
Includes harvesting and grafting of bone or cartilage grafts.
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