R163 – Simple excision of pre-malignant lesion - Other Areas
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Simple excision of pre-malignant lesion - Other Areas - single lesion. 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: 1. Dysplastic Nevus (nevus with dysplastic features, atypical melanocytic hyperplasia, atypical melanocytic proliferation, atypical lentiginous melanocytic proliferation or premalignant melanosis) 2. Actinic/Solar Keratosis 3. Chemical and other pre-malignant keratoses 4. Large Cell Acanthoma 5. Erythroplasia of Queryrat 6. Leukoplakia.
When to Use
- Use R163 for the simple excision of a single lesion confirmed by pathology as a dysplastic nevus, actinic keratosis, or other listed pre-malignant condition.
- Use R163 when the lesion is located in 'Other Areas' (i.e., not the face or neck, which would fall under R162).
Common Pitfalls
- Billing R163 without a corresponding pathology report in the patient's chart will trigger an automatic adjustment to a lower fee upon audit.
- Attempting to bill R163 for benign lesions like seborrheic keratosis or skin tags will result in rejection, as these are not pre-malignant.
- Billing R163 alongside a consultation or assessment on the same day is often rejected unless the assessment meets the criteria for a 'major pre-operative visit'.
Billing Tips
- Ensure the pathology report is finalized and filed before submitting the claim to avoid clawbacks during post-payment verification.
- Always use diagnostic code 232 to align with the specific requirements for pre-malignant lesion excision.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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.
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