R042 – Congenital dermoid cyst - midline, e.g. nasal
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the radical removal of the vulva. The fee for this service is comprehensive, encompassing all common elements as described in - and the specific elements of a surgical procedure. This includes the pre-operative evaluation, the operation itself, and post-operative care until the first follow-up visit. Associated services for surgical assistance (suffix 'B') and anaesthesia (suffix 'C') are claimed separately using this code with the appropriate suffix and are calculated based on basic and time units as outlined in -.
When to Use
- Use R042 for the radical surgical removal of the vulva, which is a comprehensive procedure code covering the entire surgical event.
- Use this code when the clinical documentation confirms a radical procedure, distinguishing it from minor local excisions or biopsies that would fall under different integumentary codes.
Common Pitfalls
- Billing for routine post-operative follow-up visits separately is a common error, as these are included in the comprehensive fee for R042.
- Attempting to claim a hospital admission assessment on the same day as the surgery is prohibited unless it qualifies as the 'major pre-operative visit' where the decision to operate was finalized.
- Failure to document the Injury Severity Score (ISS) in the medical record will lead to the rejection of the E420 trauma premium, even if the procedure itself is eligible.
Billing Tips
- Ensure that if an assistant (suffix B) or anaesthesiologist (suffix C) is involved, their claims are linked to the R042 procedure to ensure proper unit calculation based on the major procedure fee.
- Verify that any after-hours premiums (E409 or E410) are only applied to non-elective procedures or elective cases delayed by an intervening emergency, as routine elective surgeries do not qualify.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Female Genital Surgical Procedures
All insured services must be documented in appropriate medical records to establish that the service was provided, was medically necessary, and matches the service claimed, as per .
To claim the E420 trauma premium, the medical record must list the patient's Injury Severity Score (ISS).
Female
A second assistant's service is only eligible for payment following authorization by a medical consultant and requires submission of a letter from the surgeon outlining the reason the second assistant was required.
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