R160 – Simple excision of pre-malignant lesion - Face or Neck
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This code is for the simple excision of a single pre-malignant lesion located on the face or neck. The amount payable will be adjusted to a lesser fee if the pathologist’s report is not retained in the patient’s record. Excision is only payable for specific lesions including Dysplastic Nevus, Actinic/Solar Keratosis, Chemical and other pre-malignant keratoses, Large Cell Acanthoma, Erythroplasia of Queryrat, and Leukoplakia. Claims should be submitted with diagnostic code 232. In-situ lesions like Lentigo Maligna and Bowen's Disease are considered malignant and not covered by this code.
When to Use
- Use for the simple excision of a biopsy-confirmed actinic keratosis on the face or neck where the pathology report is retained in the patient chart.
- Use for the excision of a dysplastic nevus on the face or neck, provided the lesion does not meet the criteria for malignant in-situ diagnosis.
- Use for the removal of leukoplakia on the face or neck when the procedure is a simple excision rather than a more complex reconstruction.
Common Pitfalls
- Billing R160 for in-situ lesions like Bowen’s Disease or Lentigo Maligna, which are classified as malignant and are ineligible for this code.
- Failing to retain the pathology report in the patient record, which triggers an automatic fee reduction upon audit.
- Using R160 for lesions located on the trunk or extremities, as this code is strictly restricted to the face and neck.
Billing Tips
- Ensure the pathology report is filed immediately post-procedure to support the full fee in the event of a Ministry audit.
- If the procedure is performed in a clinic setting outside of a hospital, remember to append the E542 code to capture the additional $12.65 fee.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
pathologist’s report must be retained in the patient’s record
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