All codes
T565
T565 – T565
OHIP Other Code · Schedule of Benefits
When to Use
- Use T565 for the surgical excision of a malignant lesion of the skin or mucous membrane when the lesion diameter is greater than 2 cm and requires a complex closure.
- Select T565 over simpler excision codes like T560 or T561 when the anatomical location necessitates a formal flap or graft to achieve primary closure.
Common Pitfalls
- Billing T565 alongside a separate excision code for the same lesion is considered unbundling and will result in a rejection.
- Failure to document the specific size of the lesion and the complexity of the closure often leads to audit recovery if the claim is downgraded to a lower-value excision code.
Billing Tips
- Always include the pathology report reference number in your billing notes to justify the malignant diagnosis and the necessity of the complex excision procedure.
Provider Fee$552.56
Specialist Fee$552.56
Effective: February 1, 2011
Since Apr 2004, this fee has increased 4.0% vs 13.4% CPI inflation
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