R041 – Malignant lesion excision - three or more lesions
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service covers the simple excision of three or more malignant lesions, including the biopsy of each lesion. This fee is for excisions performed on areas of the body other than the face or neck. Payment is conditional on a pathologist's report being retained in the patient's record. A pre-malignant lesion is not a malignant lesion for the purposes of payment. If the resulting defect is repaired using techniques such as advancement flap including undermining of more than 2.5 cm per side, rotation, transposition, Z-plasty, or other flap or graft, the claim should be for the appropriate benefit listed under Skin Flaps and Grafts Section instead of foregoing excision benefits. Excision by S-plasty technique is considered a form of simple excision rather than a reconstructive flap.
When to Use
- Use R041 when performing a simple excision of three or more distinct malignant lesions located on the trunk or extremities.
- Use R041 when the procedure is limited to simple excision and closure, specifically excluding cases requiring complex reconstructive flaps or grafts.
Common Pitfalls
- Billing R041 for pre-malignant lesions (e.g., actinic keratosis) will lead to audit recovery, as the code strictly requires a malignant diagnosis confirmed by pathology.
- Failing to retain the pathologist's report in the patient's record is a primary cause for claim rejection or clawback during an OHIP audit.
- Incorrectly using R041 when the defect requires a flap or graft; in these instances, you must bill the appropriate code from the Skin Flaps and Grafts section instead.
Billing Tips
- Ensure the pathology report clearly identifies each of the three or more lesions as malignant to substantiate the use of the 'three or more' code over individual excision codes.
- If performing the procedure in an office setting, remember to append the E542 premium to the R041 claim to capture the additional fee for non-hospital surgical services.
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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