R139 – Transplantation of free island toe or finger
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Transplantation of free island toe or finger with microvascular anastomosis(es) and tendon nerve and bone repair. This is a major surgical procedure performed by a surgeon (Suffix 'A'), and may be supported by an assistant (Suffix 'B') and an anaesthesiologist (Suffix 'C'). The fees for assistant and anaesthesia services are calculated based on basic units plus time-based units as described in the General Preamble on pages - and -.
When to Use
- Use R139 for free tissue transfer of a toe or finger involving microvascular anastomosis, tendon repair, nerve repair, and bone fixation.
- Select R139 when the procedure involves a free island flap transfer; do not use for simple digit amputations or local pedicle flaps which are billed under different codes.
Common Pitfalls
- Billing R139 as a standalone procedure when additional procedures are performed at the same site; ensure you review the Schedule of Benefits for rules regarding multiple procedure billing and potential fee reductions.
- Failing to document the microvascular anastomosis and the specific repairs (tendon, nerve, bone) in the operative report, which is essential to justify the complexity of R139 over simpler reconstructive codes.
- Attempting to bill for a second assistant without prior approval; R139 does not carry automatic entitlement for a second assistant, and a letter of justification is required for payment.
Billing Tips
- Ensure the operative note explicitly details the microvascular component, as this is the defining feature that distinguishes R139 from standard reconstructive procedures.
- If the procedure is performed on a patient under 16 years of age following trauma, confirm the Injury Severity Score (ISS) is documented in the chart to support the E420 trauma premium.
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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