R085 – Split thickness skin graft - minor, medium sized areas
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R085 is a fee code for a surgical procedure from the Integumentary System section of the OHIP Schedule of Benefits. The description is 'Minor, medium sized areas, e.g. small or skin ulcer, breast, etc'. The fee for the surgeon is payable with suffix A. Assistant (B) and Anaesthetist (C) services are also payable and their fees are calculated based on basic units and time units as outlined in the General Preamble.
When to Use
- Use R085 for split-thickness skin grafts on localized defects, such as chronic ulcers or small traumatic skin losses, where the size does not warrant the higher-valued R086.
- Select R085 when performing a graft to a breast site following minor excision or localized tissue loss.
Common Pitfalls
- Billing R085 alongside R117 is prohibited; ensure you are not claiming for both the graft and the excision of the lesion if the Schedule considers them bundled.
- Failure to document the specific surface area in square centimeters creates an audit risk, as the distinction between 'minor/medium' (R085) and 'large' (R086) is size-dependent.
Billing Tips
- If the procedure is performed on an emergency basis after hours, ensure you append the appropriate E-code premium (E409 or E410) to maximize the procedural fee.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
The medical record must demonstrate the appropriateness of code claimed relative to size.
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