R297 – Malignant tumour with reconstruction
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service involves the surgical removal of a malignant tumour from the humerus bone, followed by reconstruction. As this code is marked with a '#' prefix, when performed in a hospital, the provision of premises, equipment, supplies, and personnel are funded by the hospital's global budget and are included as a constituent element of the service (see ).
When to Use
- Use R297 for the definitive en-bloc resection of a malignant humerus tumour combined with immediate reconstruction (e.g., endoprosthesis or allograft).
- Select this code when the clinical documentation confirms the diagnosis of a malignant bone tumour, distinguishing it from benign lesions or simple curettage procedures.
Common Pitfalls
- Billing R297 for simple biopsies or non-malignant bone surgeries will lead to audit recovery; ensure pathology reports support the 'malignant' diagnosis.
- Attempting to unbundle the reconstruction component by billing additional surgical codes is prohibited, as the fee for R297 is comprehensive for the entire procedure.
Billing Tips
- Ensure the '# ' prefix is respected; do not bill for hospital supplies or tray fees as these are covered under the hospital's global budget per GP13.
- If the procedure qualifies as an emergency or trauma case, ensure the appropriate premium (E409, E410, or E420) is appended to the claim to maximize the procedural fee.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
As this service is denoted with a '#' prefix, for services performed in a hospital, the premises, equipment, supplies, and personnel used to perform all elements of the service are funded by the hospital global budget.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.