R040 – Simple excision of two malignant lesions (other areas)
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service covers the simple excision of two malignant lesions, including biopsy of each lesion, on any area of the body except the face or neck. A pre-malignant lesion is not considered a malignant lesion for payment purposes. The amount payable for this service will be adjusted to a lesser fee if the pathologist's report is not retained in the patient's record. If the surgical defect is repaired using an advancement flap, rotation flap, transposition flap, Z-plasty, or other graft, the appropriate repair code from the Repair Section should be claimed instead of this excision code.
When to Use
- Use R040 when performing a simple excision of exactly two malignant lesions on the trunk or extremities, provided no complex repair (flap or graft) is required.
- Use this code for the excision of two distinct malignant lesions during the same encounter, rather than billing two separate single-lesion excision codes like R041.
Common Pitfalls
- Billing R040 for pre-malignant lesions (e.g., actinic keratosis) will result in a clawback or rejection upon audit, as the Schedule of Benefits explicitly restricts this code to malignant diagnoses.
- Claiming R040 when a flap or graft is used to close the defect is a common error; in these cases, you must bill the appropriate code from the Repair Section instead of the excision code.
- Failing to retain the pathology report in the patient's record is a primary audit risk that triggers an automatic reduction to a lesser fee.
Billing Tips
- If the procedure is performed in a non-hospital setting, ensure you append the E542 premium to capture the additional $12.65 fee.
- If the excision is performed in a hospital to achieve tumour-free margins confirmed by frozen section, remember to add the E540 25% premium to the base fee.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
The pathologist's report must be retained in the patient's record.
A pre-malignant lesion is not a malignant lesion for the purposes of payment.
When excision of benign, pre-malignant or malignant lesions are corrected by advancement, rotation, transposition, Z-plasty, flap or graft, claim appropriate benefit listed under Repair Section instead of foregoing excision benefits.
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