R134 – Elevation of free island skin and bone flap and closure of defect
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This surgical service involves the elevation of a free island skin and bone flap and includes the closure of the resulting defect at the donor site. It is a component of microvascular free tissue transfer procedures. This service is often performed in conjunction with R135 (Preparation of microvascular recipient site for free island skin and bone flap) and R136 (Transplantation of free island skin and bone flap with microvascular anastomosis(es) and bone fixation).
When to Use
- Use R134 specifically for the harvest of a composite free flap containing both skin and bone, such as a fibular free flap or a radial forearm flap with bone.
- Use this code as the primary procedural fee for the donor site work, distinct from the recipient site preparation (R135) and the microvascular anastomosis (R136).
Common Pitfalls
- Billing R134 as a standalone procedure; it is intended to be part of a multi-code microvascular sequence and will be flagged if the corresponding R136 is missing from the claim.
- Failure to document the specific components of the flap; ensure the operative report explicitly details both the skin and bone components to justify the use of this specific code over simpler soft-tissue-only flap codes.
Billing Tips
- Always bill R134 in conjunction with R135 and R136 to ensure the full scope of the microvascular free tissue transfer is captured and processed correctly.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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