R091 – Complex full thickness graft - eyelid, nose, lip, face
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R091 is a surgical procedure listed in the Integumentary System section of the Schedule of Benefits. As a surgical code, it is eligible for billing with suffix 'A' for the surgeon, 'B' for a surgical assistant, and 'C' for an anaesthesiologist. The fees for the assistant and anaesthesiologist are calculated based on a system of basic units (specific to the procedure) and time units, as outlined in the General Preamble (-). Various premiums may apply, such as those for age, after-hours services, and trauma.
When to Use
- Use R091 for full-thickness skin grafts specifically involving the eyelid, nose, lip, or face where the complexity of the anatomical site justifies the higher fee compared to standard graft codes.
- Select R091 when performing a full-thickness graft to reconstruct a defect in the specified facial regions, ensuring the documentation clearly distinguishes this from simpler split-thickness procedures.
Common Pitfalls
- Billing R091 on the same day as R117 will result in an automatic rejection, as these services are mutually exclusive per the Schedule of Benefits.
- Failing to document the specific anatomical location (eyelid, nose, lip, or face) can lead to audit recovery, as the fee is site-specific.
Billing Tips
- Ensure the operative report explicitly details the full-thickness nature of the graft to support the use of R091 over less complex integumentary repair codes.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
The medical record must demonstrate the appropriateness of codes claimed relative to size of graft.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.