R993 – Excision of tumours not specifically listed
OHIP Radiology Code — SURGICAL PREAMBLE · Schedule of Benefits
R993 is a code used for the excision of tumours not specifically listed in the Schedule of Benefits. As per , claims for R993 are made on an Independent Consideration (IC) basis. According to , services listed as IC are given independent consideration by a medical consultant. The claim must be submitted with a supporting letter explaining the fee, an operative or consultation report, and a comparison of the scope and difficulty of the procedure to comparable listed procedures.
When to Use
- Use R993 for the excision of rare or complex tumours that lack a specific fee code in the Schedule of Benefits, such as deep-seated soft tissue masses not covered by standard excision codes.
- Use R993 when the procedure involves a unique anatomical site or pathological complexity that renders standard integumentary excision codes (e.g., S061, S062) clinically inappropriate.
Common Pitfalls
- Do not use R993 for minor variations of listed procedures; if a procedure is essentially a standard excision but slightly more difficult, it is not an IC case.
- Failure to provide a comparative analysis against a listed procedure (e.g., comparing the complexity of R993 to a specific S-code) will result in an automatic rejection or a significant reduction in payment.
- Submitting R993 without an attached operative report is a common cause for claim rejection, as the medical consultant cannot verify the scope of the procedure without it.
Billing Tips
- When drafting your supporting letter, explicitly state the fee you are claiming and justify it by referencing the time, technical difficulty, and risk profile of a similar, listed surgical procedure.
- Always ensure your operative report details the exact size, depth, and anatomical location of the tumour to support the IC valuation during the manual review process.
Effective: January 1, 2019
SP. Surgical Preamble
SURGICAL PREAMBLE
Surgical
Integumentary System Surgical Procedures
Claims for such services must be submitted with a supporting letter explaining the amount of the fee claimed.
Must include an appropriate operative or consultation report.
Must include a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule.
For excision of tumours not specifically listed in this Schedule, claims should be made on an IC basis (code R993). Independent Consideration also will be given (under code R990) to claims for other unusual but generally accepted surgical procedures which are not listed specifically in the Schedule (excluding non-major variations of listed procedures). In submitting claims, physicians should relate the service rendered to comparable listed procedures in terms of scope and difficulty (see General Preamble ).
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