R960 – Bone transport - circular external fixation (greater than 6 cm)
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Represents a surgical procedure listed in the Musculoskeletal System Surgical Procedures section of the OHIP Schedule of Benefits. As a surgical code, it is eligible for suffixes A (surgeon), B (assistant), and C (anaesthetist) as per the rules on . Fees for surgical assistance () and anaesthesia () are calculated based on basic and time units, though the specific units for R960 are not provided. The procedure may be eligible for various premiums, such as age-based premiums (), after-hours premiums (), and the trauma premium (), subject to their respective conditions.
When to Use
- Use R960 specifically for bone transport procedures utilizing circular external fixation where the transport distance is greater than 6 cm.
- Apply this code when managing complex limb reconstruction or segmental bone loss requiring gradual distraction osteogenesis via circular frame.
Common Pitfalls
- Billing R960 for transport distances of 6 cm or less, which may be subject to audit or rejection; ensure the operative report explicitly documents the transport distance.
- Failure to document the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium alongside R960, leading to automatic rejection.
- Incorrectly billing R960 as a primary procedure when it is performed as part of a more extensive reconstruction that might be better represented by a different musculoskeletal code.
Billing Tips
- Ensure the operative report clearly delineates the circular external fixation technique and the specific measurement of the bone transport to justify the 'greater than 6 cm' requirement.
- When performing R960 on an emergency basis, verify that the procedure meets the 'non-elective' criteria before appending after-hours premiums like E409 or E410.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
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.
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