R154 – Extensive major plastic surgery procedure
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A classification for an extensive major plastic surgical procedure. This code is used when a procedure's complexity is extensive major, especially for staged procedures or those difficult to define. The responsible specialist should classify the procedure and claim accordingly. An operative report is required to be submitted with the claim for professional assessment.
When to Use
- Use for complex, staged reconstructive procedures that lack a specific, defined procedural code in the Schedule of Benefits.
- Use for extensive, major plastic surgical reconstructions where the complexity significantly exceeds standard surgical codes and requires individual professional assessment.
Common Pitfalls
- Attempting to use R154 for laceration repairs, which are strictly excluded and must be billed under the specific laceration repair sections.
- Submitting the claim without the mandatory operative report, which will trigger an automatic rejection or request for manual review.
- Billing by General Practitioners or Emergency Medicine physicians, as this code is restricted to specific surgical specialties.
Billing Tips
- Ensure the operative report clearly highlights the 'extensive' nature of the procedure to justify the R154 fee over lower-tier codes like R150-R153.
- Always verify if the procedure qualifies for age-based premiums or after-hours premiums (E409/E410) to maximize the claim, provided the clinical criteria are met.
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.
R150, R151, R152, R153, and R154 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.
R150, R151, R152, R153, and R154 are not eligible for payment to physicians in the following specialties: General and Family Practice (00) and Emergency Medicine (12).
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