R147 – Mastectomy - male (benign) - subcutaneous with nipple preservation
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A unilateral subcutaneous mastectomy with nipple preservation. This procedure is indicated for the treatment of benign male breast disease including: - adolescent gynecomastia - gynecomastia secondary to endocrine or genetic disorders (e.g. Klinefelter's Syndrome) - gynecomastia secondary to chemotherapy This surgical procedure has 6 basic units for an assistant and 7 basic units for an anaesthetist. Prior approval from the ministry is not required for this service. Removal of male breast fat tissue by liposuction is not an insured service.
When to Use
- Use R147 for unilateral subcutaneous mastectomy with nipple preservation specifically for adolescent gynecomastia or gynecomastia resulting from endocrine/genetic disorders like Klinefelter's Syndrome.
- Use R147 for patients requiring surgical correction of gynecomastia secondary to chemotherapy treatment.
Common Pitfalls
- Billing R147 for liposuction-only procedures will result in rejection, as fat removal by liposuction is not an insured service under this code.
- Attempting to bill R147 for cosmetic gynecomastia correction without a documented underlying medical or endocrine pathology will lead to audit risks and potential recovery of funds.
Billing Tips
- Ensure the diagnosis code clearly reflects the underlying medical condition (e.g., endocrine disorder or chemotherapy-induced) to justify the medical necessity of the procedure.
- If performing bilateral procedures, ensure you are billing the appropriate codes for both sides, as R147 is strictly defined as a unilateral service.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
Male
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