R152 – Intermediate plastic surgery procedure
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
`<p>R152</p>` is used for an intermediate plastic surgery procedure. The performing specialist classifies the procedure as very minor (R150), minor (R151), intermediate (R152), major (R153), or extensive major (R154). Benefits are claimed according to the tariff, but for cases that are difficult to define, 'I.C' (Independent Consideration) should be used. The fee for anaesthesia is based on 7 basic units plus time units. The fee for a surgical assistant is based on 6 basic units plus time units.
When to Use
- Use R152 for intermediate plastic surgery procedures that do not have a specific, higher-valued fee code in the Schedule of Benefits.
- Use R152 when a procedure is staged or complex enough to exceed the scope of R150 or R151, but does not meet the criteria for major (R153) or extensive major (R154) classification.
- Use R152 as a placeholder for plastic surgical interventions that are difficult to define by standard codes, provided the documentation justifies the 'intermediate' complexity level.
Common Pitfalls
- Billing R152 for the repair of lacerations will result in an automatic rejection; you must use the specific laceration repair codes found in the Integumentary System section.
- Submitting R152 without an operative report or detailed descriptive notes will lead to claim rejection, as professional assessment is required for these non-specific codes.
- Attempting to bill R152 as a General or Family Practitioner (00) or Emergency Medicine physician (12) is prohibited and will be rejected.
Billing Tips
- Always attach a clear, concise operative report to your claim to justify the 'intermediate' classification and avoid manual review delays.
- If the procedure complexity is truly unique and does not fit the R150-R154 scale, bill as 'I.C.' (Independent Consideration) rather than forcing it into R152.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
Descriptive details of procedure (e.g. operative report) should be submitted with claims for codes R150 - R154 for professional assessment.
Taking of skin by a surgeon for grafting by an Oral Surgeon - claim as R150.
`<p>R150, R151, R152, R153, and R154</p>` are not eligible for payment for the repair of any laceration(s). See repair of laceration services in the Integumentary System Surgical Procedures section of this Schedule.
`<p>R150, R151, R152, R153, and R154</p>` are not eligible for payment to physicians in the following specialties: General and Family Practice (00) and Emergency Medicine (12).
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