R952 – Double level correction - circular external fixation
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R952 is a surgical procedure listed in the Musculoskeletal System section of the Schedule of Benefits. As a surgical code, it is eligible for billing with suffix 'A' for the surgeon, 'B' for a surgical assistant, and 'C' for an anaesthetist. Fees for assistant and anaesthetist services are calculated based on a combination of basic units (specific to the procedure, but not provided in the given context) and time units, as detailed in the General Preamble (-, -). Various premiums for after-hours services, patient age, and trauma may be applicable.
When to Use
- Use R952 when performing a formal double-level osteotomy or deformity correction utilizing a circular external fixation device (e.g., Ilizarov or Taylor Spatial Frame).
- Select R952 specifically for multi-level corrections; do not use it for single-level fixation, which may be covered under different musculoskeletal procedure codes.
Common Pitfalls
- Billing R952 alongside other fracture fixation codes for the same anatomical site is often rejected; ensure the procedure is distinct and not considered an inclusive component of a primary fracture repair.
- Failure to document the specific levels of correction in the operative report can lead to audit recovery, as the code explicitly requires a 'double level' correction.
Billing Tips
- If the procedure is performed on a trauma patient meeting the Injury Severity Score (ISS) criteria, ensure the ISS is documented in the chart to support the 50% E420 trauma premium.
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 that establish the service was provided, the service claimed is the service that was rendered, and the service was medically necessary. See for details.
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