R591 – Tumour excision - superficial
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
R591 is a surgical procedure for the excision of a superficial tumour. Payment for this service is made to the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C) according to the rules in the Schedule of Benefits. The surgeon's fee is the listed amount. Fees for the surgical assistant and anaesthetist are calculated based on a system of basic and time units as outlined in the General Preamble (, ).
When to Use
- Use R591 for the excision of a discrete superficial soft tissue mass, such as a lipoma or epidermal inclusion cyst, that does not involve deep fascia or muscle.
- Select R591 when the procedure involves a formal surgical excision rather than a simple shave biopsy or curettage, which are billed under different codes.
Common Pitfalls
- Billing R591 alongside a consultation or assessment code on the same day is often rejected unless the decision to perform the surgery was made during a separate, distinct encounter.
- Attempting to bill R591 for multiple lesions in the same anatomical region without applying the multiple procedure rule (50% reduction for subsequent procedures) will lead to audit flags.
- Claiming a second surgical assistant for R591 will result in an automatic rejection, as it is not on the pre-approved list and requires prior medical consultant authorization.
Billing Tips
- Ensure the operative report clearly describes the depth of the lesion as 'superficial' to justify R591 over more complex musculoskeletal excision codes.
- If the excision requires a complex closure, verify if the closure code is eligible for separate billing or if it is considered inclusive of the R591 fee under the General Preamble.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Payment for surgical assistant (suffix B) services is calculated using a unit-based system. The fee is the sum of basic units (listed as Asst in the Schedule) and time units, multiplied by the assistant unit fee. Time units are calculated per 15 minutes of service. See and for detailed calculation rules.
Payment for anaesthesiologist (suffix C) services is calculated using a unit-based system. The fee is the sum of basic units (listed as Anae in the Schedule) and time units, multiplied by the anaesthesiologist unit fee. Time units are calculated per 15 minutes of service. See and for detailed calculation rules.
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