R043 – Congenital dermoid cyst - infant or child
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This billing code represents a surgical procedure within the integumentary system. Payment is structured for the primary surgeon (suffix A), a surgical assistant (suffix B), and an anaesthetist (suffix C). The fees for assistant and anaesthesia services are unit-based, calculated by adding basic units (specific to the procedure) and time units, as detailed in the -. Additional premiums may apply for services rendered after hours (E409, E410), for specific patient age groups (), or in trauma cases (E420). Anaesthesia complexity may be accounted for with extra units for patient status (e.g., ASA classification) or specific surgical conditions ().
When to Use
- Use R043 for the surgical excision of a confirmed congenital dermoid cyst in a pediatric patient.
- Select this code when the procedure is performed as a distinct surgical event, rather than as part of a more extensive reconstructive or plastic surgery procedure.
Common Pitfalls
- Billing R043 in conjunction with other minor integumentary procedures without ensuring they are not bundled under the Schedule's multiple procedure rules.
- Failing to apply the mandatory age-based premium (GP64) for patients under 16, which is a common oversight that results in underpayment.
- Incorrectly coding the procedure as a simple excision (e.g., R990) when the specific congenital diagnosis and pediatric age criteria for R043 are met.
Billing Tips
- Always verify the patient's exact age at the time of the procedure to ensure the correct percentage-based age premium is appended to the R043 base fee.
- If the procedure is performed after hours, ensure the appropriate E-code premium is applied to the primary surgeon's fee, and verify that the surgical assistant and anaesthetist also bill their respective after-hours modifiers.
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 establishing that the service was provided, is the service submitted for payment, and was medically necessary. See Appendix G of the Schedule for full details.
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