R127 – Transplantation of free island skin and muscle flap with microvascular anastomosis(es)
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Transplantation of free island skin and muscle flap with microvascular anastomosis(es). This procedure is part of a series for free island flap reconstruction, which often includes elevation of the flap (e.g., R125) and preparation of the recipient site (e.g., R126). Assistant and Anaesthetist Fees: - **Assistant Fee (R127B):** The fee is calculated based on basic and time units as described in the Schedule of Benefits on page . - **Anaesthetist Fee (R127C):** The fee is calculated based on basic and time units as described in the Schedule of Benefits on pages and . Additional units may apply based on patient factors (e.g., age, BMI) as listed on page .
When to Use
- Use R127 specifically for the microvascular anastomosis phase of a free tissue transfer, distinct from the flap elevation (R125) and recipient site preparation (R126).
- Apply this code when performing complex reconstruction requiring the reconnection of vessels to restore blood supply to a transferred island skin and muscle flap.
Common Pitfalls
- Billing R127 alone without including the associated R125 and R126 codes often leads to claim rejection or underpayment for the full surgical sequence.
- Failing to reduce the recipient site preparation fee (R126) by 15% when the excision and preparation are performed by different surgeons is a frequent audit trigger.
- Submitting a claim for a second assistant without the mandatory letter of justification from the surgeon will result in automatic denial of the assistant fee.
Billing Tips
- Ensure the microvascular anastomosis is clearly documented in the operative report to support the use of R127 over simpler flap codes like R122.
- Always verify if the procedure qualifies for E409 or E410 premiums if performed after hours, as these significantly increase the procedural fee for non-elective reconstructions.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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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