R641 – Major tumour
OHIP Radiology Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the excision of a major tumour from the clavicle or acromion. This code is designated with a '#' prefix, indicating that when performed in a hospital or an Integrated Community Health Services Centre (ICHSC), the cost of premises, equipment, supplies, and personnel are included in the facility's funding and not billed separately by the physician (see ). The service includes pre-operative and post-operative care as outlined in the Surgical Preamble.
When to Use
- Use R641 for the surgical excision of a significant tumour specifically located within the clavicle or acromion.
- Select this code when the clinical documentation confirms a major tumour resection, distinguishing it from minor soft tissue excisions or simple biopsies.
Common Pitfalls
- Billing R641 in addition to a consultation or assessment on the same day is generally disallowed under the Surgical Preamble, as pre-operative care is included.
- Attempting to bill R641 for minor excisions or superficial lesions will lead to audit recovery; ensure the operative report clearly supports the 'major tumour' classification.
Billing Tips
- Ensure the operative report explicitly details the anatomical involvement of the clavicle or acromion to justify the use of this specific code over general musculoskeletal excision codes.
- Verify that the surgical assistant and anaesthesia units are calculated based on the 6 and 7 base units respectively, applying any eligible after-hours or trauma premiums to the total fee.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
This procedure is listed with 6 base units for an Assistant (Asst) and 7 base units for Anaesthesia (Anae).
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