R164 – Simple excision of two pre-malignant lesions (other areas)
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R164 is a surgical procedure listed in the Integumentary System section of the Schedule of Benefits. As a surgical procedure, it is eligible for payment to the performing surgeon (suffix A), a surgical assistant (suffix B), and an anaesthetist (suffix C). The fees for the assistant and anaesthetist are calculated based on basic units and time units as outlined in the General Preamble (-, -). The surgeon's pre-operative admission assessment is not separately payable unless it is the 'major pre-operative visit' where the decision to operate was made (). The procedure cannot be delegated ().
When to Use
- Use R164 when performing a simple excision of exactly two distinct pre-malignant lesions, such as actinic keratoses, on body areas other than the face or scalp.
- Choose R164 over R163 when the clinical documentation confirms the removal of two separate lesions rather than a single lesion.
Common Pitfalls
- Billing R164 alongside a minor assessment code (e.g., A007) is a common audit trigger; the assessment is only payable if it is the major pre-operative visit where the decision to operate was made.
- Failure to retain the pathology report in the patient's record will result in a mandatory fee reduction, as the Schedule of Benefits requires pathological confirmation for pre-malignant lesion excisions.
Billing Tips
- If performing the procedure in your office rather than a hospital setting, ensure you append the E542 premium to receive the additional $12.65 payment.
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 appropriate medical records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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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