R068 – Preparation of microvascular recipient site for innervated free island skin and subcutaneous flap
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Preparation of microvascular recipient site for innervated free island skin and subcutaneous flap. This is a major surgical procedure involving the meticulous preparation of the recipient area, including the identification and dissection of blood vessels (artery and vein) and a nerve, to which a transplanted flap will be attached via microvascular and neural anastomoses. This service includes all common and specific surgical elements as defined in the Schedule, such as pre-operative evaluation, the procedure itself, and immediate post-operative care.
When to Use
- Use R068 specifically for the preparation of a recipient site requiring both microvascular anastomosis and neural anastomosis for an innervated free flap.
- Select R068 when the procedure involves the meticulous identification and dissection of a recipient artery, vein, and nerve, distinguishing it from simpler flap preparation codes like R064 or R065 that lack the neural component.
Common Pitfalls
- Failing to apply the 15% reduction to the fee when the excision of the lesion and the preparation of the recipient site are performed by different surgeons.
- Attempting to claim a second surgical assistant without prior authorization, as R068 does not qualify for automatic second assistant payment.
- Overlooking the requirement to document the specific nerve identified and dissected, which is essential to justify the use of this code over standard microvascular preparation codes.
Billing Tips
- Ensure the operative report explicitly details the neural anastomosis, as this is the defining clinical requirement that differentiates R068 from other microvascular recipient site preparation codes.
- If a second surgical assistant is medically necessary, submit the surgeon's explanatory letter concurrently with the claim to avoid immediate rejection.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
If a second surgical assistant is required, a letter from the surgeon outlining the reason must be submitted for authorization by a medical consultant.
When performed by a Medical Trainee under supervision, the medical record must identify the Supervising Physician, the Medical Trainee and their level of training, a description of the service, patient consent, and be signed off by the Supervising Physician as per the rules outlined in .
Note: When excision of the lesion and preparation of the recipient site are carried out by different surgeons, the preparation fees should be reduced by 15%.
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