R216 – Radical resection tumour
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This billing code represents a surgical procedure falling under the 'Musculoskeletal System' section of the OHIP Schedule of Benefits. The specific text for this code is 'Radical resection tumour'. General Surgical Rules: - Suffixes: This procedure is billed with suffixes: 'A' for the surgeon, 'B' for the surgical assistant, and 'C' for the anaesthesiologist (). - Assistant/Anaesthesia Fees: Fees for assistant and anaesthesia services are calculated based on a combination of basic units and time units, as detailed in the General Preamble (, ). - Premiums: Various premiums may be applicable, including age-based premiums for children, after-hours premiums for non-elective procedures, and a trauma premium (, , ). For further details, please consult the 'Musculoskeletal System Surgical Procedures' section of the OHIP Schedule of Benefits.
When to Use
- Use for wide local excision of malignant musculoskeletal tumours where the surgical objective is to achieve clear margins beyond the tumour pseudocapsule.
- Use for definitive oncologic resections of soft tissue sarcomas or primary bone tumours where R216 is the most appropriate descriptor for the radicality of the procedure.
Common Pitfalls
- Billing R216 for simple excisions or biopsies; ensure the procedure meets the definition of a 'radical resection' to avoid audit recovery.
- Failing to document the specific anatomical margins achieved, which is critical to justifying the 'radical' nature of the resection during a post-payment review.
- Attempting to bill R216 in conjunction with other excision codes for the same lesion; ensure the procedure is not considered an 'inclusive' component of a more comprehensive surgical package.
Billing Tips
- Ensure the operative report explicitly describes the extent of the resection and the tissue planes involved to substantiate the high-value fee associated with R216.
- If the procedure is performed on a trauma patient, ensure the Injury Severity Score (ISS) is documented in the chart to support the addition of the E420 trauma premium.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate 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 ().
When claiming the trauma premium (E420), the medical record must list the patient's Injury Severity Score (ISS) ().
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