R158 – Level 2 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Level 2 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy. Payment Rules: 1. R158 is only eligible for payment when: - a. resected breast volume exceeds 15% of ipsilateral breast parenchyma, or - b. when the tumour is resected from the upper inner quadrant or the lower pole of the breast. 2. R158 is only eligible for payment when the operative report documents purposeful skin excision, glandular rotations, pre-emptive nipple recentralization, and de-epithelialization techniques that preserve the blood supply to the nipple-areolar complex and parenchyma.
When to Use
- Use R158 when performing a partial mastectomy for malignancy where the resection involves the lower pole or upper inner quadrant, necessitating oncoplastic reconstruction techniques.
- Use R158 when the volume of breast tissue resected exceeds 15% of the total ipsilateral breast parenchyma, requiring glandular rotation to prevent deformity.
Common Pitfalls
- Billing R158 without explicit operative documentation of both skin excision and glandular rotation techniques will lead to audit recovery.
- Attempting to bill R158 for standard lumpectomies that do not meet the 15% volume threshold or specific quadrant criteria is a frequent cause of claim rejection.
- Failure to document the specific oncoplastic techniques used, such as pre-emptive nipple recentralization and de-epithelialization, renders the claim non-compliant with the Schedule of Benefits.
Billing Tips
- Ensure the operative report clearly quantifies the resection volume or specifies the quadrant to justify the use of R158 over a standard partial mastectomy code like R111.
- Always append E525 if the lesion was localized with wire or seeds, and E546 if an axillary node dissection up to the axillary vein was performed, as these are distinct, billable add-ons.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
The operative report must document purposeful skin excision, glandular rotations, pre-emptive nipple recentralization, and de-epithelialization techniques that preserve the blood supply to the nipple-areolar complex and parenchyma.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.