R226 – Biopsy of suspected sarcoma or resection of complex bone or soft tissue tumour
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A time-based service for the biopsy of a suspected sarcoma, or the resection of a complex bone or soft tissue tumour. The fee is payable per 15 minutes of operating time. Time calculation for the surgeon (R226A) includes all resection and reconstruction components of the procedure. Fees for assistant and anaesthesia services are calculated based on a combination of base units and time units.
When to Use
- Use R226 for the definitive resection of a complex soft tissue sarcoma or primary bone tumour where the complexity necessitates specialized oncological training.
- Use R226 for an open biopsy of a suspected sarcoma when the procedure is the primary surgical service being performed.
- Use R226 for complex tumour resections that involve significant reconstruction components, as these are included in the time-based calculation.
Common Pitfalls
- Claiming R226 when it is not the major procedure; in such cases, you must revert to standard biopsy or excision codes from the Schedule.
- Failing to exclude time spent acting as a surgical assistant from your R226A claim, as assistant time is ineligible for this code.
- Submitting R226 for an amputation of a non-malignant tumour, which must instead be billed using the specific amputation codes found in the Schedule.
Billing Tips
- Ensure your ministry profile is updated with your fellowship training or certification documentation, as claims will be rejected if your credentials are not on file.
- When billing R226A for a second surgeon, always include the operative report and a letter of explanation to justify the necessity of two oncological surgeons for the manual review process.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
R226 is eligible for payment only to an oncological orthopaedic surgeon with fellowship training in orthopaedic oncology; or an oncological sarcoma general surgeon with either completed Society of Surgical Oncology training prior to 2013 or Royal College of Physicians and Surgeons of Canada certification in general surgical oncology. Documentation of completed fellowship training and/or certification must be provided to the ministry prior to submitting a claim for R226.
Submit R226A claims for a second surgeon using the manual review indicator and accompanied by the operative report and a letter of explanation regarding the need for two oncological surgeons.
If the nature, complexity and/or length of the procedure require(s) two oncological orthopaedic or general surgeons to render components of the same procedure simultaneously or sequentially, R226A is eligible for payment to each surgeon for the period that each provided primary surgical services.
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