R038 – Moderate burns
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Anaesthesia or surgical assistant services for the treatment of moderate burns. The fee is determined by basic units plus time-based units. The Schedule of Benefits on page defines a moderate burn as: - 10% to 20% Total Body Surface Area (TBSA) burn in an adult (age 10 to 50 inclusive). - 5% to 10% TBSA burn in the young (age 9 and under) or old (age 51 and over). - 2% to 5% TBSA full thickness burn at any age. - Or, regardless of TBSA or age, any of the following: - high-voltage injury - suspected inhalation injury - circumferential burn - concomitant medical problem predisposing to infection (e.g. diabetes, sickle cell disease)
When to Use
- Use R038 when providing anaesthesia or surgical assistance for burns meeting the specific TBSA percentages defined in M11, such as 10-20% for adults or 5-10% for children.
- Use R038 for any burn, regardless of TBSA, if the patient presents with high-voltage injury, suspected inhalation injury, or a circumferential burn.
- Use R038 for patients with pre-existing medical conditions that increase infection risk, such as diabetes or sickle cell disease, when undergoing surgical burn treatment.
Common Pitfalls
- Billing R038 for minor burns that do not meet the M11 TBSA thresholds or the specific high-risk criteria, which will lead to claim rejection or audit recovery.
- Failing to document the specific TBSA percentage or the qualifying high-risk condition (e.g., inhalation injury) in the patient record, which is required to justify the use of this code over standard surgical assistant or anaesthesia codes.
- Incorrectly applying the E420 Trauma Premium without documenting the required Injury Severity Score (ISS) in the medical record, which is mandatory for this specific premium.
Billing Tips
- Ensure the suffix (B for surgical assistant, C for anaesthesiologist) is correctly appended to R038, as the fee structure and eligible premiums differ significantly between the two roles.
- When billing for patients under 16, always verify if the age-based percentage increase (GP64) is applied to the R038B surgical assistant fee, as this is a specific entitlement not available for all surgical codes.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures, Anaesthesiologists' Services, Surgical Assistants' Services
For burn care requiring anaesthesiologists’ and assistants’ services, the following fee codes apply.
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