R165 – Excision of pre-malignant lesions - three or more lesions
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of three or more pre-malignant lesions from areas other than the face or neck. The amount payable for this service will be adjusted to a lesser fee if the pathologist’s report is not retained in the patient’s record. This procedure is only payable for specific types of pre-malignant lesions including Dysplastic Nevus, Actinic/Solar Keratosis, Chemical and other pre-malignant keratoses, Large Cell Acanthoma, Erythroplasia of Queryrat, and Leukoplakia.
When to Use
- Use R165 when you perform the excision of three or more distinct pre-malignant lesions (such as actinic keratoses or dysplastic nevi) located on the trunk or extremities.
- Use this code specifically when the surgical procedure is performed on non-facial and non-neck regions, as lesions on the face or neck require different billing codes.
Common Pitfalls
- Failing to retain the pathology report in the patient's record will result in a mandatory downward adjustment of the fee, as the Ministry requires pathological confirmation for these specific diagnoses.
- Billing R165 for fewer than three lesions is a common audit trigger; if you excise only one or two lesions, you must use the appropriate single or two-lesion excision codes instead.
- Attempting to bill R165 for benign lesions that do not meet the specific criteria (e.g., simple seborrheic keratoses) will lead to claim rejection or recovery upon audit.
Billing Tips
- Ensure your operative note explicitly lists the anatomical location of each of the three or more lesions to justify the use of this specific code over individual excision codes.
- Always cross-reference the pathology report findings with the specific list of eligible pre-malignant conditions (e.g., Dysplastic Nevus, Leukoplakia) to ensure the claim remains compliant.
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 records that establish the service was provided, the service claimed is the service rendered, and the service was medically necessary, as per .
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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