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R159
R159 – Level 3 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy
OHIP Radiology Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Level 3 oncoplastic breast conserving lumpectomy or partial mastectomy for malignancy. This procedure can be billed with the following add-on codes when specific requirements are met: - E505: with limited axillary node sampling. - E525: after localization with mammographic wire or radioactive seeds. - E546: with axillary node dissection up to the level of the axillary vein.
When to Use
- Use R159 for breast-conserving surgery involving complex oncoplastic techniques, such as glandular rearrangement or volume displacement, that exceed the scope of standard lumpectomy codes like R102.
- Select R159 when the malignancy requires a partial mastectomy that necessitates specific oncoplastic reconstruction to maintain breast shape and symmetry.
Common Pitfalls
- Billing R159 in conjunction with Z427 (sentinel node biopsy) is a common error; E505 is the designated add-on for limited axillary sampling with this code.
- Failing to document the specific oncoplastic technique used can lead to audit scrutiny, as R159 implies a higher level of complexity than standard partial mastectomy codes.
- Attempting to bill E546 for axillary dissection without ensuring the procedure reached the level of the axillary vein, as this is a strict requirement for the add-on fee.
Billing Tips
- Always verify if localization was performed; if mammographic wire or radioactive seeds were used, ensure E525 is included to capture the additional fee.
- When performing axillary node dissection, confirm the extent of the dissection against the requirements for E546 to ensure the $388.75 add-on is appropriately claimed.
Provider Fee$701.15
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
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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