R036 – Pilonidal cyst - excision and skin shift
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Represents a surgical procedure classified under the Integumentary System. This service includes all standard pre-operative, intra-operative, and post-operative care as defined in the and of the Schedule of Benefits. Specific details of the procedure are not available in the provided context, but it is categorized as an Integumentary System Surgical Procedure per the index on page .
When to Use
- Use R036 for the definitive surgical excision of a pilonidal cyst that requires a skin shift or flap reconstruction (e.g., Limberg or Z-plasty) to close the defect.
- Select R036 when the procedure involves more than simple primary closure, distinguishing it from minor excision codes like S052 or S053 which are intended for simple cysts or lesions without complex tissue rearrangement.
Common Pitfalls
- Billing R036 for simple incision and drainage (I&D) of an abscess; I&D procedures must be billed under appropriate codes like Z355, as R036 specifically requires excision and skin shift.
- Attempting to bill R036 in addition to a consultation fee on the same day; per the Schedule of Benefits, the surgical fee includes the pre-operative assessment unless the consultation meets the specific criteria for a separate claim.
Billing Tips
- Ensure the operative report explicitly describes the 'skin shift' or flap technique used, as this is the defining component that justifies the higher fee compared to standard excision codes.
- If the procedure is performed on an urgent basis after hours, remember to append the appropriate after-hours premium (E409 or E410) to the R036 claim to increase the procedural fee by the specified percentage.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Urogenital and Urinary 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.
Specific details for this procedure code are not available in the provided context. It is classified under Integumentary System Surgical Procedures as per the Schedule index on page .
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