R687 – Knee arthroscopy set-up, degenerative disease of the knee
OHIP Radiology 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.
When to Use
- Use R687 as the base procedure code when performing arthroscopic knee surgery for degenerative joint disease, provided you are also billing an eligible add-on like E494, E495, or E476.
- Use R687 in conjunction with E476 when removing a symptomatic intra-articular loose body or loose screw that is causing mechanical symptoms, provided the procedure is not part of a broader debridement (E493 or E489).
Common Pitfalls
- Billing R687 for arthroscopic lavage alone is an uninsured service and will be rejected or clawed back; it must be accompanied by a valid, eligible procedural add-on.
- Failing to document the Kellgren-Lawrence grade or the failure of six months of conservative management when billing E494 or E495 with R687 will lead to audit failure.
- Attempting to bill R687 with arthroscopic codes outside of the approved E-code list (E494, E495, E476) will result in automatic rejection.
Billing Tips
- Always document the specific mechanical symptoms and the duration of failed non-surgical treatment in the operative note to satisfy the requirements for E494 and E495.
- Include photographic evidence of the intra-articular pathology in the patient record, as this is strongly recommended to support the medical necessity of E495 and R687.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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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