R125 – Elevation of free island skin and muscle flap and closure of defect
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This surgical service covers the elevation of a free island flap composed of both skin and muscle tissue from a donor area. The procedure also includes the closure of the defect created at the donor site. This flap is typically prepared for subsequent microvascular transplantation to a recipient site. - The surgeon's fee (suffix A) is a flat rate. - The surgical assistant's fee (suffix B) is calculated based on basic and time units. Time is determined per operation as the total of time spent by the physician in direct contact with the patient in the operating room prior to scrub time to assist with patient preparation, and time spent by the physician assisting at the patient's surgery starting with scrub time and ending when the physician is no longer required to be in attendance with that patient. Time units are calculated for each 15 minutes or part thereof. The unit value of each 15 minute period or part thereof is: 1 unit during the first hour or less; 2 units after the first hour up to and including the first 1.75 hours; 3 units after 1.75 hours (). - The anaesthesiologist's fee (suffix C) is calculated based on basic and time units. Time is calculated from when the anaesthesiologist is first in attendance until they are no longer required, with 1 unit per 15 minutes for the first hour, 2 units per 15 minutes after the first hour up to 1.5 hours, and 3 units per 15 minutes after 1.5 hours ().
When to Use
- Use R125 for the harvesting of a free muscle-skin flap (e.g., Latissimus Dorsi or Rectus Abdominis) specifically intended for microvascular transfer to a distant recipient site.
- Use this code when the procedure includes the primary closure of the donor site defect, as this is bundled into the R125 fee.
Common Pitfalls
- Do not bill R125 in conjunction with R126 (preparation of recipient site) without applying the mandatory 15% reduction to the preparation fee if performed by the same surgeon.
- Avoid billing R125 for local or pedicled flaps; it is strictly for free flaps requiring microvascular anastomosis, which are billed separately under different codes.
- Ensure the surgical assistant and anaesthesiologist time units are calculated precisely according to the specific GP86 and GP93 schedules, as over-reporting time is a frequent audit trigger.
Billing Tips
- If the excision of the lesion and the preparation of the recipient site are performed by different surgeons, ensure the 15% reduction is applied to the preparation code (e.g., R126) to avoid automatic claim rejection.
- Always document the specific anatomical site of the flap harvest and the closure technique used at the donor site to support the R125 claim during post-payment review.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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