R028 – Scar revision - other areas (5.1 cm to 10 cm)
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical revision of a scar, with any method of closure, for scars measuring 5.1 cm to 10 cm in length. This code applies to anatomical areas other than the face or neck. The service is eligible for suffix A (surgeon), B (assistant), and C (anaesthetist). * Surgeon (A): The fee is as listed in the Schedule. It is eligible for After Hours premiums (E409, E410), the Trauma premium (E420), and age-based premiums for patients under 16 (). The add-on E542 is payable when performed outside a hospital. * Assistant (B): The fee is calculated based on 6 base units plus time units as per rules on pages -. It is eligible for after-hours premiums (E400B, E401B), special visit premiums (), and the Trauma premium (E420). * Anaesthetist (C): The fee is calculated based on 6 base units plus time units as per rules on pages -. It is eligible for after-hours premiums (E400C, E401C), special visit premiums (), anaesthesia extra units (), and the Trauma premium (E420). Requirement: Authorization is required for all scar revisions in areas other than the face or neck, as per the note on page (see Appendix D).
When to Use
- Use R028 for the surgical revision of a scar measuring 5.1 cm to 10 cm located on the trunk or extremities, where the procedure is medically necessary to restore function or address symptomatic pathology.
- Select R028 when the scar length falls strictly within the 5.1 cm to 10 cm range; scars shorter than 5.1 cm should be billed under R027, and those exceeding 10 cm under R029.
Common Pitfalls
- Failure to obtain and document prior authorization as required by the Schedule (Appendix D) will result in automatic claim rejection for this code.
- Billing R028 for scars located on the face or neck is a common error; these anatomical areas are excluded and require different codes from the R017-R023 series.
- Inaccurate measurement of the scar length is a frequent audit trigger; ensure the clinical record clearly justifies the length measurement used for the 5.1 cm to 10 cm category.
Billing Tips
- If the procedure is performed in a non-hospital setting, ensure you append the E542 premium to the claim to capture the additional $11.55 fee.
- Always verify that the patient's age-based premium (GP64) is applied correctly if the patient is under 16, as this is a percentage-based increase on the base fee of R028.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
Authorization is required for all scar revisions in areas other than the face or neck (see Appendix D).
Authorization is required for all scar revisions in areas other than the face or neck (see Appendix D).
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