R128 – Elevation of free island muscle flap with tendon and nerve, and closure of defect
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Elevation of free island muscle flap with tendon and nerve, and closure of defect. This procedure is a component of microvascular free tissue transfer for complex reconstruction.
When to Use
- Use R128 specifically for the elevation of a free island muscle flap that includes both a tendon and a nerve component as part of a complex microvascular reconstruction.
- Select R128 when the procedure involves the harvesting of a composite tissue unit where the inclusion of the tendon and nerve is essential to the functional outcome of the transfer.
Common Pitfalls
- Billing R128 in conjunction with other flap elevation codes (such as R123 or R124) for the same tissue site is a common cause of rejection due to bundling rules for complex reconstructions.
- Failure to clearly document the inclusion of both the tendon and the nerve in the operative report will lead to audit adjustments, as these are specific requirements for this code compared to standard muscle flap codes.
Billing Tips
- Ensure the operative report explicitly details the dissection and isolation of the tendon and nerve to justify the higher fee associated with R128 compared to simpler flap elevation codes.
- When performing multiple procedures during the same session, ensure that the major procedure is identified correctly to comply with the rule that assistant and anaesthetist fees are based on the primary procedure only.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record 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.
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