R962 – Humeral lengthening - circular external fixation (greater than 6 cm)
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R962 is a surgical procedure listed under the Integumentary System section of the OHIP Schedule of Benefits. As a surgical code, the fee is payable with suffixes: - A for the physician performing the procedure. - B for a physician assisting at the surgery. - C for a physician administering the anaesthetic. The specific details of the surgical service, including pre-operative and post-operative care components, are not available in the provided context. Additional premiums may be applicable, such as those for services provided after hours (E409, E410), for patients within specific age groups (see ), or for trauma cases (E420).
When to Use
- Use R962 specifically for humeral lengthening procedures utilizing circular external fixation where the lengthening distance exceeds 6 cm.
- Select this code when the surgical intent is limb lengthening; do not use it for standard fracture stabilization or non-lengthening external fixation procedures.
Common Pitfalls
- Billing R962 for lengthening procedures of 6 cm or less, which may be subject to recovery if the clinical documentation does not support the required threshold.
- Attempting to claim E420 (Trauma premium) alongside after-hours premiums (E409/E410); these are mutually exclusive and the claim will be rejected if both are submitted for the same service.
- Failing to document the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, which is a mandatory audit requirement.
Billing Tips
- Ensure the surgical report explicitly quantifies the lengthening achieved to justify the use of R962 over other potential musculoskeletal fixation codes.
- Always verify the patient's age at the time of the procedure to automatically apply the appropriate age-based premium, as these are not always automatically calculated by all billing software.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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