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R107
R107 – Tumour or tissue for diagnostic biopsy and/or treatment
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This surgical procedure involves the excision of a tumour or tissue from the breast. It is performed for diagnostic biopsy, treatment, or both. The procedure covers conditions such as carcinoma, fibroadenoma, or fibrocystic disease, and the fee applies whether a single or multiple excisions are performed on the same breast.
When to Use
- Use R107 for the surgical excision of a breast tumour or tissue, such as a fibroadenoma or suspected carcinoma, where the primary intent is diagnostic biopsy or therapeutic removal.
- Use R107 when performing a breast biopsy or excision that requires localization with a mammographic wire or radioactive seeds, ensuring E525 is added to the claim.
Common Pitfalls
- Do not bill R107 for simple fine-needle aspiration (FNA) or core needle biopsies, as these are typically covered under different diagnostic codes rather than surgical excision codes.
- Avoid billing R107 multiple times for multiple excisions on the same breast; the code is defined as covering single or multiple excisions per breast, so additional claims will be rejected as duplicate services.
Billing Tips
- Always append E525 to R107 when the procedure involves pre-operative localization with wire or radioactive seeds to capture the additional $48.05 fee.
- Ensure the operative report clearly documents the excision of tissue or tumour to support the surgical nature of the claim if audited against non-surgical diagnostic procedures.
Provider Fee$169.95
Surgical Assistant Fee$75.06
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Category
M. Integumentary System Surgical Procedures
Subcategory
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Integumentary System Surgical Procedures
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