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E546
E546 – Axillary node dissection
OHIP Surgical Assists Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Add-on fee for an axillary node dissection up to the level of the axillary vein. This code is payable in addition to R111 (Partial mastectomy or wedge resection for treatment of breast disease), R102 (Level 1 oncoplastic breast conserving lumpectomy), R158 (Level 2 oncoplastic breast conserving lumpectomy), or R159 (Level 3 oncoplastic breast conserving lumpectomy).
When to Use
- Use E546 when performing a formal axillary node dissection up to the axillary vein in conjunction with a partial mastectomy (R111) or oncoplastic breast conserving surgery (R102, R158, R159).
- Select E546 for therapeutic axillary clearance when malignancy is confirmed, distinguishing it from the diagnostic sentinel node biopsy procedure (Z427).
Common Pitfalls
- Billing E546 alongside Z427 is a common rejection; Z427 is for sentinel node biopsy, while E546 is for the formal dissection procedure.
- Attempting to bill E546 as a standalone procedure will result in rejection, as it is strictly an add-on code requiring an eligible primary surgical code like R111.
Billing Tips
- Ensure the operative report clearly documents the dissection level up to the axillary vein to justify the E546 fee over lesser node sampling procedures.
- If a sentinel node biopsy (Z427) is performed and subsequently converted to a full dissection due to positive frozen section results, bill both Z427 and E546 to capture the full scope of the procedure.
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