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E529
E529 – Breast mound creation by prosthesis
OHIP Surgical Assists Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This code is an add-on to R118 (Breast skin reconstruction by local flaps or grafts) and provides payment for the creation of a breast mound using a prosthesis as part of the same procedure. It is used in the context of post-mastectomy breast reconstruction.
When to Use
- Use E529 as an add-on to R118 when performing post-mastectomy breast reconstruction specifically involving the insertion of a breast prosthesis.
- Select E529 when the surgical plan involves a synthetic implant or expander to create the breast mound, rather than using autologous tissue.
Common Pitfalls
- Billing E529 in conjunction with E513 will result in an automatic rejection, as you cannot claim both prosthesis-based and soft-tissue-based mound creation for the same site.
- Failure to link E529 to the primary procedure code R118 on the same claim will lead to payment denial, as E529 is strictly an add-on code.
Billing Tips
- Ensure R118 is billed as the primary procedure to trigger the eligibility for the E529 add-on fee.
- If the procedure is performed after hours or on a weekend, apply the appropriate premium (E409 or E410) to the total procedural fee, including the E529 component.
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