R045 – Rotations, transpositions, Z-plasties - face, neck or scalp - Defect less than 2 cm average diameter
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A skin flap procedure involving rotation, transposition, or Z-plasty to repair a defect of less than 2 cm average diameter on the face, neck, or scalp. Per a Note: on page , this procedure includes undermining, with the specifics depending on the site and size. The preamble to Skin Flaps and Grafts states that additional procedures other than the skin grafting are payable in addition to the skin flap or grafts, e.g. tendon grafts, inlay grafts, etc.
When to Use
- Use R045 for reconstruction of a facial or scalp defect under 2 cm using a transposition or rotation flap, which is distinct from simple primary closure codes like R002.
- Select R045 for Z-plasty procedures on the face or neck intended to release tension or redirect scars, provided the defect size meets the criteria.
Common Pitfalls
- Billing R045 when the procedure is actually a simple excision or primary closure; ensure the operative report explicitly describes the flap movement (rotation, transposition, or Z-plasty).
- Confusing R045 with R046; R045 is strictly for defects less than 2 cm, while R046 applies to defects 2 cm or greater.
- Attempting to bill R045 in addition to a primary closure code for the same site; the flap procedure is inclusive of the closure.
Billing Tips
- Ensure the operative note clearly documents the average diameter of the defect to justify the use of R045 over higher-tier flap codes.
- If performing an excision for tumour-free margins with frozen section, remember to append E540 to R045 to receive the 25% premium.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
Includes undermining but will depend on the site and size.
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