R957 – Single level correction - circular external fixation
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This code represents a surgical procedure from the Musculoskeletal System section of the Schedule of Benefits. Specific details about this procedure are not available on page beyond its title. Payment for this service includes the surgical procedure itself (suffix A), as well as separate calculations for surgical assistance (suffix B) and anaesthesia (suffix C). The fees for assistant and anaesthesia services are calculated based on basic units plus time units as outlined in the General Preamble (-). Various premiums for age, after-hours services, and trauma may also be applicable.
When to Use
- Use R957 for the application of a circular external fixator (e.g., Ilizarov or Taylor Spatial Frame) specifically for a single-level bone correction or lengthening procedure.
- Select this code when the clinical intent is a controlled, single-level osteotomy or deformity correction managed via circular frame mechanics, rather than simple fracture stabilization.
Common Pitfalls
- Billing R957 alongside other fracture fixation codes for the same anatomical site is a common audit trigger; ensure the procedure is distinct and not part of a global surgical package.
- Failure to document the specific 'single level' nature of the correction can lead to denials if the Ministry interprets the procedure as a multi-level or complex reconstruction requiring a different code.
- Incorrectly applying trauma premiums (E420) without explicit documentation of the Injury Severity Score (ISS) in the patient record will result in automatic rejection.
Billing Tips
- Ensure the operative report clearly defines the 'single level' correction to justify the use of R957 over more complex or generic musculoskeletal surgical codes.
- When calculating assistant (suffix B) and anaesthesia (suffix C) fees, verify the specific basic units assigned to R957 in the Schedule of Benefits to ensure accurate unit-based billing.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
As per , all insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
The amount payable for the surgical assistant service (suffix 'B') is calculated by adding together the number of basic and time units and multiplying that total by the unit fee of $12.51. The number of basic units is the number of units listed opposite the service in the column headed with 'Asst'. Time units are calculated based on time spent assisting. (, )
The amount payable for the anaesthesia service (suffix 'C') is calculated by adding the number of basic and time units and multiplying the total by the anaesthesiologist unit fee of $15.49. The number of basic units is the number of basic units listed opposite the service in the column headed with 'Anae'. Time units are calculated based on time spent by the anaesthesiologist. (, )
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