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R011
R011 – Advancement flap - face, neck or scalp - defect 2.1 to 5 cm
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Advancement flap on the face, neck or scalp for a defect measuring 2.1 to 5 cm. Note: This procedure is intended to include undermining of more than 2.5 cm per side and also includes the excision of a lesion if this is the technique of closure. See () for details.
When to Use
- Use R011 when performing a formal advancement flap on the face, neck, or scalp where the defect size is between 2.1 and 5 cm and significant undermining (greater than 2.5 cm per side) is required for closure.
- Use this code when the excision of a lesion is performed as part of the same procedure and the advancement flap is the chosen method of reconstruction for the resulting defect.
- Select R011 instead of simple excision codes (like R003 or R004) when the complexity of the repair involves the mobilization of adjacent tissue via an advancement flap to achieve closure.
Common Pitfalls
- Billing R011 for simple linear closures or excisions that do not meet the specific requirement of undermining greater than 2.5 cm per side; this is a common audit trigger for over-billing.
- Attempting to bill an assessment code (e.g., A007) on the same day as R011; the Schedule of Benefits explicitly prohibits payment for an assessment during the same encounter as a surgical procedure unless specifically listed.
- Failing to document the defect size and the extent of undermining in the operative report, which is essential to justify the use of a flap code over a standard excision code.
Billing Tips
- If performing a tumour excision in a hospital setting with frozen section confirmation, ensure you append E540 to the R011 claim to receive the 25% premium.
- Always verify the defect size measurement post-excision; if the defect is 2.0 cm or smaller, you must use R002, and if it exceeds 5 cm, you must use R012.
Provider Fee$89.85
Surgical Assistant Fee$75.06
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Category
M. Integumentary System Surgical Procedures
Subcategory
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Integumentary System Surgical Procedures
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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