R005 – Myocutaneous, myogenous or fascia-cutaneous flaps - specific muscle flaps
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R005 is a surgical procedure of the integumentary system. A key payment rule, found on , states that when more than one assistant is required for this surgical procedure, the second assistant's service is only eligible for payment following authorization by a medical consultant and requires submission of a letter from the surgeon outlining the reason the second assistant was required. This service is eligible for standard surgical, assistant, and anaesthesia after-hours and age-based premiums.
When to Use
- Use R005 for the transfer of a specific muscle flap, such as a latissimus dorsi or rectus abdominis flap, for reconstructive purposes.
- Use R005 when performing a fascia-cutaneous flap that involves the elevation and transposition of a specific vascularized tissue unit.
- Use R005 for complex wound coverage where the procedure requires the mobilization of a myocutaneous unit, distinguishing it from simple skin grafts or random pattern flaps.
Common Pitfalls
- Do not bill R005 for simple closure or local tissue rearrangement; ensure the procedure meets the definition of a specific myocutaneous or myogenous flap.
- Do not bill for the closure of the donor site separately, as this is explicitly included in the R005 fee.
- Failing to obtain prior medical consultant authorization for a second surgical assistant will lead to automatic rejection of the assistant's claim.
Billing Tips
- If a second assistant is medically necessary, submit the surgeon's letter of justification concurrently with the claim to avoid delays in medical consultant review.
- Ensure the operative report clearly details the vascular pedicle and the specific muscle or fascia-cutaneous unit used to support the R005 code during potential audits.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Digestive 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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