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R156
R156 – Breast mound creation by insertion of tissue expander
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Breast mound creation by insertion of a tissue expander is a surgical repair procedure performed as part of post-mastectomy breast reconstruction. The service includes the creation of a submuscular pocket for the expander. It is eligible for an add-on fee (E514) when performed immediately following a mastectomy during the same anaesthetic session. This procedure is not payable with Z132.
When to Use
- Use R156 for the primary insertion of a tissue expander to create a submuscular pocket during a post-mastectomy breast reconstruction procedure.
- Use R156 when performing a staged reconstruction where the expander is placed to prepare the site for a future permanent implant.
Common Pitfalls
- Billing R156 in conjunction with Z132 will result in an automatic rejection as they are mutually exclusive codes.
- Failing to include the E514 add-on code when the expander is placed immediately following the mastectomy during the same anaesthetic session results in lost revenue.
- Attempting to bill R156 alongside other breast reconstruction codes that are restricted by the Schedule of Benefits, leading to claim denials.
Billing Tips
- Always append E514 to your claim for R156 if the reconstruction is immediate to capture the additional $200 flat fee.
- Ensure the operative report clearly describes the creation of the submuscular pocket to support the R156 billing if audited.
Provider Fee$425.00
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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