R685 – Tendon release with tenodesis - biceps
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This billing code represents a surgical procedure. The specific nature of this procedure is not detailed in the provided context as its listing on page was not available. As a surgical service, payment is available for the surgeon (suffix A), assistant (suffix B), and anaesthesiologist (suffix C), calculated using a unit-based system detailed in the General Preamble (-). This code is associated with G685A, for which the technical component is payable at 86.10% of the listed 'T' fee when rendered in a hospital ().
When to Use
- Use R685 for the definitive surgical management of biceps tendon pathology requiring release and tenodesis, distinguishing it from simple debridement or tenotomy procedures.
- Select this code when the procedure is performed as a standalone surgical intervention or as the primary component of a shoulder reconstruction involving the biceps anchor.
Common Pitfalls
- Billing R685 in conjunction with other shoulder arthroscopy codes without confirming if the procedure is considered 'inclusive' under the General Preamble multiple procedure rules.
- Failing to document the specific tenodesis technique used, which is required to justify the surgical complexity associated with R685 compared to a simple release.
Billing Tips
- Ensure that the surgical report clearly differentiates the tenodesis from any concurrent rotator cuff repair, as these are often billed as separate procedural items if distinct anatomical sites are addressed.
- Verify the hospital setting for G685A to ensure the technical component is correctly calculated at 86.10% of the listed fee, preventing common reconciliation errors.
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 claimed is the service rendered, and the service was medically necessary ().
For services where payment is based on time units (e.g., anaesthesia, surgical assistance), the start and end times must be recorded in the patient's permanent medical record ().
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