R003 – Advancement flap - other areas - defect 5.1 to 10 cm
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
An advancement flap procedure for a defect measuring 5.1 to 10 cm, located on areas other than the face, neck, or scalp. The note on page of the Schedule of Benefits specifies this procedure is intended to include the excision of a lesion if this is the technique of closure, and also includes undermining of more than 2.5 cm per side. The preamble to skin flaps on page states that additional procedures other than the skin grafting (e.g., tendon grafts, inlay grafts) are payable in addition.
When to Use
- Use for an advancement flap on the trunk or extremities where the defect size is between 5.1 and 10 cm and requires extensive undermining of more than 2.5 cm per side.
- Use when the primary surgical technique for closing a 5.1 to 10 cm non-facial defect involves advancing adjacent tissue, which inherently includes the excision of the lesion itself.
Common Pitfalls
- Billing R003 in addition to a separate excision code (e.g., S050, S051) is a common error, as the Schedule of Benefits explicitly states R003 includes the excision of the lesion.
- Attempting to bill R003 for defects smaller than 5.1 cm or larger than 10 cm; ensure the measured defect size is clearly documented to support the specific code range.
- Applying R003 to facial, neck, or scalp procedures, which are restricted to different codes in the R-series (e.g., R002 or R004 depending on size and location).
Billing Tips
- If performing a malignant lesion excision in a hospital with frozen section confirmation, remember to append E540 to R003 to capture the 25% premium.
- Document the extent of undermining in the operative report to justify the use of the flap code over a simple closure, as the code specifically requires undermining of more than 2.5 cm per side.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
All insured services must be documented in appropriate records that establish the service was provided, is the service submitted, and was medically necessary, as per .
To include undermining of more than 2.5 cm per side. Is intended to include excision of a lesion if this is technique of closure.
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