R226

PDF page 585 / N5

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
 GENERAL FEES
                                                                              Asst      Surg       Anae
     ORTHOPAEDIC/GENERAL SURGERY COMPLEX BONE OR SOFT TISSUE TUMOUR
     SURGERY
   R226 Biopsy of suspected sarcoma, or resection of a complex bone
           or complex soft tissue tumour(s), per 15 minutes .............. 10 150.00 15
      Payment rules:
      1.R226 is eligible for payment only to:
            a.an oncological orthopaedic surgeon with fellowship training in orthopaedic oncology; or
            b.an oncological sarcoma general surgeon with either completed Society of Surgical
              Oncology training prior to 2013 or Royal College of Physicians and Surgeons of Canada
              certification in general surgical oncology
         Documentation of completed fellowship training and/or certification must be provided to the
         ministry prior to submitting a claim for R226.
         [Commentary:
         Surgeons eligible to claim R226 will typically be working within a multidisciplinary sarcoma
         subspecialty group.]
         2.R226 is a time based service. Except when rendering the services of a surgical assistant,
           time calculation for the purpose of R226A includes all resection and reconstruction
           components of the procedure rendered by the physician claiming R226A.
         [Commentary:
         For any period of time that a surgeon claiming R226A renders the services of an assistant, the
         time spent assisting constitutes surgical assist time and is not eligible for payment as time for
         the purpose of R226A.]
         3.Biopsy of suspected sarcoma, or resection of a complex bone or complex soft tissue
           tumour(s) is not eligible for payment as R226 when rendered in conjunction with another
           procedure(s) by the same surgeon when the biopsy or tumour resection is not the major
           procedure.
         [Commentary:
         In these circumstances (payment rule 3), use the appropriate fee code listing in the Schedule
         under biopsy or excision of bone or soft tissue.]
         4.R226 is eligible for payment for complex tumour resection by amputation only when the
           tumour resected is malignant.
         [Commentary:
         For other tumour resection by amputation, use the appropriate fee code listing in the Schedule
         under amputation.]
         5.If the nature, complexity and/or length of the procedure require(s) two oncological
           orthopaedic or general surgeons to render components of the same procedure
           simultaneously or sequentially, R226A is eligible for payment to each surgeon for the period
           that each provided primary surgical services.
         Claims submission instructions:
         Submit R226A claims for a second surgeon using the manual review indicator and
         accompanied by the operative report and a letter of explanation regarding the need for two
         oncological surgeons.

PDF page 586 / N6

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
GENERAL FEES
                                                                           Asst         Surg         Anae
    [Commentary:
    In accordance with the Surgical Preamble, if a surgeon who is not an oncological orthopaedic
    surgeon or an oncologic sarcoma general surgeon renders a specialized component of the
    procedure (eg reconstructive flaps or grafts), the surgeon should claim the appropriate fee
    code(s) from the Schedule for the service(s) rendered.]
    6.Time calculation commences when the surgeon begins the procedure and ends when the
      surgeon leaves the operating room.
    7.Time unit calculation is based on full 15 minute time units.
    Medical record requirements:
    This service is eligible for payment only if start and stop times of the service are recorded in the
    patient's permanent medical record.
    [Commentary:
    Any surgeon rendering R226A should also record in the patient's permanent medical record
    the start and stop times of surgical assistant services when rendered.]

Master, record 4460. Record Layout PDF, page 1.

R22620260401999999990000000000000001291000000015000000000239400000002394000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.