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R216
R216 – Radical resection tumour
OHIP Musculoskeletal System Surgical Procedures 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.
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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