R006 – Pectoralis major flap
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs posterior spinal instrumentation. This is a surgical procedure and must be billed with suffix <suffix>A</suffix> by the operating surgeon. It is eligible for several add-on premiums. The fee for assistant services (billed with suffix <suffix>B</suffix>) is calculated by combining basic units and time units (). The fee for anaesthesia services (billed with suffix <suffix>C</suffix>) is also calculated using basic and time units (), and may be eligible for extra units based on patient factors like age or medical condition ().
When to Use
- Use R006 for the reconstruction of soft tissue defects using a pectoralis major myocutaneous or muscle flap.
- Select R006 when the procedure is performed as a primary reconstructive step following head and neck cancer resection or trauma.
Common Pitfalls
- Billing R006 without the required 'A' suffix, which will result in an automatic rejection for surgical claims.
- Attempting to bill a second surgical assistant without prior authorization from a medical consultant, as R006 is not on the pre-approved list for multiple assistants.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, which is a mandatory audit requirement.
Billing Tips
- Ensure that after-hours premiums (E409/E410) are only applied when the procedure commences within the specified time windows and meets the non-elective criteria.
- When billing anaesthesia (R006C), maximize the claim by identifying and applying all eligible extra unit premiums (e.g., ASA status, BMI, or age) as outlined in GP97.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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