R295 – Bone tumour - simple excision
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of bone tumour - simple excision. This procedure is subject to general rules for surgical procedures (suffix 'A'), surgical assistance (suffix 'B'), and anaesthesia (suffix 'C') as detailed in the General Preamble of the OHIP Schedule of Benefits.
When to Use
- Use R295 for the simple excision of a benign bone tumour where the procedure does not involve complex reconstruction or extensive grafting.
- Use this code for symptomatic osteoid osteomas or enchondromas that require surgical removal but do not meet the criteria for more complex codes like R296 (excision of bone tumour with grafting).
Common Pitfalls
- Billing R295 in conjunction with a biopsy code for the same lesion is often rejected; ensure the excision is the primary procedure and the pathology is incidental to the removal.
- Failing to document the specific size or anatomical location can lead to audit scrutiny, as R295 is intended for 'simple' excisions only.
- Attempting to bill R295 alongside a more comprehensive orthopedic procedure on the same bone will trigger a 'multiple procedure' reduction or rejection; ensure the excision is distinct and medically necessary.
Billing Tips
- Always append the appropriate suffix (A for surgeon, B for assistant, C for anaesthesia) to ensure the claim processes correctly against the Schedule of Benefits.
- If the procedure is performed after hours, ensure the start time is clearly documented in the operative report to support the application of E409 or E410 premiums.
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 that establish: 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.
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