R161 – Simple excision of two pre-malignant lesions (Face or Neck)
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Simple excision of two pre-malignant lesions (Face or Neck). The amount payable for excision of a pre-malignant lesion will be adjusted to a lesser fee if the pathologist’s report is not retained in the patient’s record. Excision of a pre-malignant lesion is only payable for the following lesions: Dysplastic Nevus, Actinic/Solar Keratosis, Chemical and other pre-malignant keratoses, Large Cell Acanthoma, Erythroplasia of Queryrat, Leukoplakia.
When to Use
- Use R161 specifically when performing a simple excision of exactly two pre-malignant lesions located on the face or neck during the same encounter.
- Use this code only when the pathology report confirms one of the six eligible diagnoses: Dysplastic Nevus, Actinic/Solar Keratosis, Chemical/other pre-malignant keratoses, Large Cell Acanthoma, Erythroplasia of Queryrat, or Leukoplakia.
Common Pitfalls
- Billing R161 for benign lesions (e.g., seborrheic keratosis or skin tags) will result in a clawback upon audit, as these do not meet the strict pre-malignant criteria.
- Failure to retain the pathology report in the patient's chart is a common audit failure that triggers an automatic downward adjustment of the fee.
- Do not use R161 for lesions on the trunk or extremities; those require different codes within the R-series (e.g., R164 or R165).
Billing Tips
- Always ensure the pathology report is scanned and linked to the specific encounter date in the EMR, as the Ministry may request this documentation to verify the pre-malignant diagnosis.
- If performing the procedure in your office, remember to add the E542 premium to the claim to capture the 'outside hospital' fee increase.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in the patient's medical record to establish that the service was provided, the service claimed is the service that was rendered, and the service was medically necessary, as per requirements in Appendix G of the Schedule. ()
An appropriate operative report must be maintained in the patient's medical record.
The pathologist’s report must be retained in the patient’s record, otherwise the amount payable for excision of a pre-malignant lesion will be adjusted to a lesser fee.
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