R012 – Advancement flap - face, neck or scalp - defect 5.1 to 10 cm
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Advancement flap procedure for a defect measuring 5.1 to 10 cm, located on the face, neck, or scalp. The procedure includes undermining of more than 2.5 cm per side. It is intended to include the excision of a lesion if this is the technique of closure.
When to Use
- Use R012 when performing an advancement flap on the face, neck, or scalp for a defect between 5.1 and 10 cm, provided the procedure involves extensive undermining of more than 2.5 cm per side.
- Use this code instead of standard excision codes (e.g., Z427) when the lesion removal is integral to the flap closure technique, as the excision fee is bundled into the R012 procedural fee.
Common Pitfalls
- Billing R012 in addition to a separate excision code for the same lesion is a common error; the excision is considered part of the flap procedure and is not separately billable.
- Failure to document the extent of undermining (specifically >2.5 cm per side) puts the claim at high risk for audit recovery, as this is a mandatory requirement for the code definition.
- Under-reporting the defect size; ensure the measurement reflects the final defect size requiring the flap, as using a code for a smaller defect size will result in underpayment.
Billing Tips
- If performing an excision in a hospital setting for a malignant lesion requiring frozen section confirmation, remember to append the E540 premium to your R012 claim to increase the surgical fee by 25%.
- Always ensure your operative report explicitly describes the undermining distance and flap geometry to support the use of R012 over simpler repair codes.
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, establishing that the service was provided, is the service for which the account is submitted, and was medically necessary.
For surgical procedures, an operative report is typically required.
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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