R694 – Ankle - liner replacement
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Ankle - liner replacement is a surgical arthroplasty procedure performed on the foot and ankle, involving the replacement of a total ankle prosthesis liner. The fee for the surgeon (suffix A) is a set amount. The fee for a surgical assistant (suffix B) is calculated based on 8 base units plus time units as described in -. The fee for an anaesthesiologist (suffix C) is calculated based on 10 base units plus time units as described in -.
When to Use
- Use R694 specifically for the isolated exchange of a polyethylene liner in an existing total ankle arthroplasty when the metal components remain stable and in situ.
- Use this code when the surgical intent is limited to liner replacement, distinguishing it from more extensive revision procedures like E564 which involve component removal or replacement.
Common Pitfalls
- Billing R694 in conjunction with E564 is a common rejection error, as the Ministry explicitly prohibits concurrent billing of these codes for the same operative session.
- Failure to document the specific nature of the liner exchange can lead to audit risks if the procedure is later scrutinized for being a more complex revision arthroplasty (E564) rather than a simple liner replacement.
Billing Tips
- Ensure that surgical assistants and anaesthesiologists bill their respective time-based units correctly using the base units defined for R694 (8 units for B, 10 units for C) to avoid payment delays.
- If the procedure qualifies for age-based premiums, ensure the percentage increase is applied to both the surgeon (R694A) and the surgical assistant (R694B) claims.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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