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R004
R004 – Advancement flap - defect more than 10 cm
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
An advancement flap for a defect measuring more than 10 cm, such as a thoracic abdominal flap. Required Elements: - Must include undermining of more than 2.5 cm per side.
When to Use
- Use for large advancement flap closures on the trunk or abdomen where the defect size exceeds 10 cm and extensive undermining is required.
- Use when the primary surgical technique for closing a large excision defect involves sliding tissue into the gap, provided the undermining exceeds 2.5 cm on each side.
Common Pitfalls
- Billing R004 without explicit documentation of the 2.5 cm undermining per side, which is a mandatory requirement for this specific code.
- Attempting to bill a separate excision code (e.g., Zxxx series) in addition to R004; the fee for R004 is intended to include the excision of the lesion if the flap is the closure technique.
Billing Tips
- Ensure your operative report explicitly states the defect size (>10 cm) and the extent of undermining (>2.5 cm per side) to satisfy audit requirements.
- If performing an excision in a hospital setting with frozen section confirmation, remember to add the E540 premium to your R004 claim to increase the fee by 25%.
Provider Fee$242.70
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Category
M. Integumentary System Surgical Procedures
Subcategory
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Integumentary System Surgical Procedures
Must include undermining of more than 2.5 cm per side.
Note: 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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