R528 – Complex muscle repair
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Complex muscle repair, which includes the repair of involved skin. This service is designated for Independent Consideration (IC) as per . Claims for this service must be submitted with a supporting letter detailing the service, a copy of the operative report, and a comparison of the scope and difficulty of the procedure in relation to other listed services. See also R525A for simple muscle repair.
When to Use
- Use R528 for extensive muscle debridement and multi-layered reconstruction that exceeds the scope of a simple R525A muscle repair.
- Select this code when the procedure involves significant muscle trauma requiring complex mobilization, tissue transfer, or extensive suturing that cannot be captured by standard listed codes.
Common Pitfalls
- Failing to submit a detailed operative report and a comparative analysis against non-IC codes will result in automatic rejection or a reduced payment.
- Billing R528 for routine muscle repairs that are already adequately described by R525A is a common audit trigger for over-billing.
Billing Tips
- Ensure your supporting letter explicitly highlights the anatomical complexity, time spent, and specific techniques used to justify the IC fee request.
- Always reference the complexity of the tissue involvement compared to R525A to provide the Ministry with a clear benchmark for your requested amount.
No fee information available.
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
For Independent Consideration (IC) services, claims must be submitted with a supporting letter explaining the amount of the fee claimed, and must include an appropriate operative or consultation report, and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule.
Complex repair (see )
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