R592 – Tumour excision - deep
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is a surgical procedure for the excision of a deep tumour from soft tissues, listed under the Musculoskeletal System section of the OHIP Schedule of Benefits. The surgeon's fee (suffix A) includes the pre-operative assessment, the operation itself, and normal post-operative care. Fees for surgical assistance (suffix B) and anaesthesia (suffix C) are calculated based on basic units and time units, as described in the General Preamble starting on page .
When to Use
- Use R592 for the excision of a deep-seated soft tissue mass that requires dissection through fascia or muscle, as opposed to superficial lesions billed under R591.
- Use this code when the operative report clearly describes the depth of the tumour relative to the muscular or fascial planes to justify the 'deep' designation.
Common Pitfalls
- Billing R592 for superficial or subcutaneous lesions that do not involve deep tissue dissection, which is a common audit trigger for upcoding.
- Failing to document the specific anatomical location and depth, which is required to differentiate this from simpler excision codes like R591 or R590.
Billing Tips
- Ensure the operative report explicitly details the depth of the excision and the structures encountered to support the 'deep' classification during a post-payment review.
- If multiple tumours are excised, ensure you are applying the appropriate multiple procedure rules (50% for the second procedure) rather than billing R592 multiple times at full value.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented to establish that: 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.
Surgical procedures require an operative report in the patient's medical record.
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