J004 – Intramammary needling for localization under mammographic control
OHIP Cardio-Thoracic Surgery Code — CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS · Schedule of Benefits
Intramammary needling for localization under mammographic control is a clinical procedure designed to accurately mark a non-palpable breast lesion. This is typically done prior to a surgical biopsy or excision. The procedure uses mammography to guide the placement of a fine wire or needle into the lesion, ensuring the surgeon can precisely locate and remove the correct tissue.
When to Use
- Use J004 specifically for the placement of a localization wire or needle into a non-palpable breast lesion under mammographic guidance prior to surgical excision.
- Do not use J004 for ultrasound-guided procedures; those require different procedural codes as J004 is strictly defined by mammographic control.
Common Pitfalls
- Billing J004 in addition to a diagnostic mammogram on the same day is often flagged; ensure the procedure is distinct and the diagnostic imaging is medically necessary.
- Attempting to bill J004 for ultrasound-guided needle localizations will result in rejection, as this code is exclusively for mammographic guidance.
Billing Tips
- Ensure the referring physician's name and billing number are included in the claim, as a formal referral is a mandatory requirement for this procedure.
- If the procedure is performed on an urgent, non-elective basis in a hospital setting, verify eligibility for the C-series diagnostic premiums to maximize the claim value.
Effective: April 1, 2026
E. Clinical Procedures associated with Diagnostic Radiological Examinations
CLINICAL PROCEDURES ASSOCIATED WITH DIAGNOSTIC RADIOLOGICAL EXAMINATIONS
Procedure
Clinical Procedures associated with Diagnostic Radiological Examinations
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