R051 – Laser surgery on Group 1 - 4, pre-malignant and malignant lesions
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service is for laser surgery on Group 1 - 4, pre-malignant and malignant lesions. As an 'IC' (Independent Consideration) code, the fee is not specified and must be determined by a medical consultant based on submitted documentation, as outlined on . This code is prefixed with a '#', meaning when performed in a hospital or Integrated Community Health Services Centre (ICHSC), the facility costs (premises, equipment, supplies, personnel) are funded separately and cannot be charged to the patient. For payment, a pathologist's report must be retained in the patient's record.
When to Use
- Use R051 for laser ablation of biopsy-proven pre-malignant or malignant skin lesions where the complexity or extent of the procedure exceeds standard excision codes like Z001 or Z002.
- Use R051 when performing laser destruction of multiple or complex lesions that require an 'IC' (Independent Consideration) fee submission due to the lack of a specific fee in the Schedule.
Common Pitfalls
- Failing to retain the pathology report in the patient's chart, which triggers an automatic reduction in the paid fee upon audit.
- Submitting an IC claim without a detailed operative report and a comparative analysis of the procedure's difficulty relative to fixed-fee codes, leading to claim rejection or underpayment.
- Attempting to bill for facility or equipment costs when performing the procedure in a hospital or ICHSC, which is strictly prohibited for '#' prefixed codes.
Billing Tips
- When submitting the IC claim, explicitly reference the time, complexity, and specific laser technique used to justify the fee amount in your supporting letter.
No fee information available.
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
The amount payable for excision of a pre-malignant lesion will be adjusted to a lesser fee if the pathologist’s report is not retained in the patient’s record.
Claims for services listed as 'IC' must be submitted with a supporting letter explaining the amount of the fee claimed, and must include an appropriate operative or consultation report, and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule.
The amount payable for treatment of a malignant lesion will be adjusted to a lesser fee if the pathologist's report is not retained in the patient's record.
A pre-malignant lesion is not a malignant lesion for the purposes of payment.
# R051: For services denoted with the prefix “#” and performed in a hospital, the premises, equipment, supplies, and personnel are funded by the hospital global budget. If provided in an ICHSC, these costs are funded by the ICHSC. Patients cannot be charged for these items.
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