R976 – Lengthening with circular external fixation (greater than 6 cm)
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is a fee code for a surgical procedure classified under the Musculoskeletal System. The fee amount represents payment for the surgeon performing the procedure (suffix A). Additional fees are payable for surgical assistants (suffix B) and anaesthesiologists (suffix C), calculated based on basic and time units. Various premiums for age, after-hours services, and trauma may also be applicable. Refer to the surgical assistant and anaesthesiology sections of the General Preamble for detailed calculation rules.
When to Use
- Use R976 specifically for limb lengthening procedures exceeding 6 cm where a circular external fixation device is the primary method of stabilization.
- Select R976 when the clinical plan necessitates significant bone distraction that cannot be achieved through internal lengthening nails or simple plate fixation.
Common Pitfalls
- Billing R976 for procedures involving less than 6 cm of lengthening; ensure the surgical plan and post-operative measurements confirm the 6 cm threshold is met.
- Attempting to bill a hospital admission assessment separately; this is considered part of the 'major pre-operative visit' and is not eligible for additional payment unless it is the definitive consultation.
Billing Tips
- Always verify if the patient meets the criteria for age-based premiums (e.g., 5-16 years) to increase the base fee by the appropriate percentage, as these are often missed on surgical claims.
- If the procedure is performed as an emergency or delayed elective case, ensure the appropriate after-hours premium (E409 or E410) is applied to the R976 fee to maximize reimbursement.
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. 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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