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R687
R687 – Knee arthroscopy set-up, degenerative disease of the knee
OHIP Musculoskeletal System Surgical Procedures Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Knee arthroscopy set-up for degenerative disease of the knee. This service is a prerequisite for other arthroscopic knee procedures performed for this condition. The fee includes services such as synovial biopsy and/or resection or trimming of plica when rendered as part of the procedure. Payment for this service is subject to specific criteria, especially when performed with other procedures like meniscectomy or chondroplasty. See payment rules and commentary for conditions under which this service may be uninsured.
Pre-authorization required
When billed with E494 or E495 without prior approval, the medical record must document:
• Kellgren-Lawrence knee osteoarthritis grade less than 3 on standing knee x-rays performed within the last 12 months.
• Unstable chondral pathology or meniscal tear causing mechanical symptoms which have not responded to a minimum of six months active non-surgical treatment.
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