R956 – Humerus - circular external fixation
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R956 is a surgical procedure. As a surgical procedure, payment is subject to the general rules outlined in the Schedule of Benefits, including suffix eligibility, calculation of fees for surgical assistants (<suffixEligibility>B</suffixEligibility>) and anaesthetists (<suffixEligibility>C</suffixEligibility>) based on basic and time units, and eligibility for various premiums such as age-based (), after-hours (, , ), and trauma (E420) premiums. The specific elements and requirements for this particular surgical procedure are not detailed in the provided context.
When to Use
- Use R956 for the application of a circular external fixation device specifically for humeral fractures or reconstructions.
- Use this code when the procedure involves the definitive application of the frame, rather than simple pin insertion or temporary stabilization.
Common Pitfalls
- Billing R956 in conjunction with other fracture management codes for the same site may trigger a 'duplicate service' or 'incidental procedure' rejection if not clearly documented as distinct components.
- Failure to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium will result in an automatic rejection of the premium portion of the claim.
- Attempting to bill R956 alongside after-hours premiums (E409/E410) and the trauma premium (E420) simultaneously; these are mutually exclusive per the Schedule of Benefits.
Billing Tips
- Ensure the operative report explicitly details the circular nature of the fixation to justify the use of R956 over general external fixation codes.
- When performing bilateral procedures, ensure the second procedure is submitted with the appropriate suffix (e.g., -79) to ensure correct payment of the secondary fee.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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