E505

PDF page 548 / SP6

SURGICAL PREAMBLE
PREAMBLE
 24. Morbidly obese patients
     E676 is eligible for payment once per patient per physician in addition to the amount eligible for
     payment for the major surgical procedure(s) where a morbidly obese patient undergoes major
     surgery to the neck, thorax, peritoneal cavity, retroperitoneum, pelvis, or hip and:
    a. the patient has a Body Mass Index (BMI) greater than 40
    b. the surgery is rendered under general anaesthesia using either an open technique for the
       neck, thorax, or hip, or an open or laparoscopic technique for the peritoneal cavity, pelvis,
       retroperitoneum; and
    c. the principal surgical technique is neither aspiration, core or fine needle biopsy, dilation,
       endoscopy, mediastinoscopy, thoracoscopy, cautery, ablation nor catheterization.
E676A Morbidly obese patient, surgeon, to procedural fee(s)...... add                      25%
E676B Morbidly obese patient, surgical assistant, to major procedure
        add                                                                               6 units
     Note:
     E676A/B is only payable with the following procedures: D043, D046, D047, D052, E090, E499,
     E500, E505, E546, E589, E593, E626, E627, E655, E664, E673, E686, E697, E704, E706,
     E707, E708, E709, E711, E712, E713, E714, E718, E721, E722, E725, E728, E729, E731,
     E733, E734, E735, E736, E737, E738, E739, E743, E745, E748, E752, E754, E762, E764,
     E765, E766, E767, E768, E769, E771, E794, E796, E852, E853, E854, E855, E857, E860,
     E880, E882, E883, E884, E885, F100, F101, F135, M081, M082, M084, M090, M099, M100,
     M142, M143, M144, P018, P041, P042, P050, P055, P056, P057, P058, P059, P060, R108,
     R109, R216, R241, R269, R330, R423, R439, R440, R443, R470, R481, R488, R491, R553,
     R569, R590, R627, R628, R639, R686, R786, R800, R802, R803, R805, R806, R807, R811,
     R814, R815, R817, R823, R825, R826, R834, R839, R852, R855, R856, R858, R860, R861,
     R910, R885, R905, R913, R914, R915, R932, R933, R934, R935, R936, R937, S089, S090,
     S114, S115, S116, S117, S118, S120, S121, S122, S123, S124, S125, S128, S129, S131,
     S132, S133, S134, S137, S138, S139, S140, S149, S150, S154, S157, S158, S159, S160,
     S162, S164, S165, S166, S167, S168, S169, S170, S171, S172, S173, S175, S176, S177,
     S180, S182, S183, S184, S185, S187, S188, S189, S191, S192, S193, S194, S195, S196,
     S197, S199, S204, S207, S213, S214, S215, S217, S218, S222, S227, S265, S266, S267,
     S269, S270, S271, S274, S275, S276, S278, S280, S281, S282, S285, S287, S291, S292,
     S294, S295, S297, S298, S299, S300, S301, S302, S303, S304, S305, S306, S307, S308,
     S309, S310, S311, S312, S313, S314, S315, S318, S319, S321, S323, S325, S329, S332,
     S340, S342, S343, S344, S345, S405, S411, S416, S420, S422, S424, S427, S431, S432,
     S433, S434, S435, S436, S438, S440, S441, S445, S446, S447, S448, S449, S450, S451,
     S452, S453, S454, S455, S457, S460, S461, S462, S465, S466, S467, S468, S471, S482,
     S483, S488, S490, S491, S512, S513, S546, S549, S561, S590, S650, S651, S652, S710,
     S714, S727, S728, S729, S731, S733, S735, S736, S738, S739, S740, S741, S743, S745,
     S747, S748, S750, S751, S757, S758, S759, S760, S761, S763, S764, S766, S775, S776,
     S778, S780, S781, S782, S784, S788, S789, S790, S792, S793, S795, S798, S799, S800,
     S813, Z427, Z526, Z552, Z553, Z564, Z569, Z577, Z594, Z737, Z738

PDF page 575 / M25

OPERATIONS OF THE BREAST
                                                                                                            Asst      Surg      Anae
                               INCISION
                Needle biopsy
              Z141 - one or more ........................................................................     nil      37.20
              E542   - when performed outside hospital ............................... add                             12.65
              Z143 - large core breast biopsy - (14 gauge or larger bore needle)                                      144.85
                Aspiration of cyst
              Z139 - one or more ........................................................................     nil       37.20
      Drainage of intramammary abscess or haematoma
  # Z140 Single or multiloculated - local anaesthetic.............................                                     33.00
  # Z740 Single or multiloculated - general anaesthetic ........................                                      133.80     6
      EXCISION
  # R107 Tumour or tissue for diagnostic biopsy and/or treatment, e.g.
           carcinoma, fibroadenoma or fibrocystic disease (single or
           multiple - same breast) ......................................................                     6       169.95     6
  # E525   - after localization with mammographic wire or radioactive
             seeds, to R107........................................................... add                              48.05
  # R111 Partial mastectomy or wedge resection for treatment of breast
            disease, with or without biopsy, e.g. carcinoma or extensive
            fibrocystic disease ..............................................................                6       306.75     7
  # E525    - after localization with mammographic wire or radioactive
              seeds to R111 ............................................................ add                            48.05
  # E546    - with axillary node dissection up to the level of the axillary
              vein, to R111 .............................................................. add                        388.75
  # E505    - with limited axillary node sampling, to R111............... add                                         178.05
        Payment rules:
        1.E505 is not eligible for payment in addition to Z427.
                                         2.Z427 is only eligible for payment in addition to E546 when a frozen section report
                                           demonstrates micrometastases.
                                         [Commentary:
                                         For sentinel node biopsy refer to Z427 p R2.]

PDF page 575 / M25

Mastectomy - female (with or without biopsy)
  # R108 - simple ................................................................................. 6 330.00                     7
    E517    - with immediate postmastectomy superficial chest wall
              reconstruction, to R108...................................... add 30%
  # R117 - skin sparing mastectomy performed with immediate breast
            reconstruction for malignancy or prophylaxis in high-risk
            female patients ...................................................................     6 495.00                     7
    E486    - with nipple sparing, to R117............................... add 30%
  # E505    - with limited axillary node sampling, to R108 or R117 add                                178.05
        Payment rules:
        1.E517 is only eligible for payment when the surgeon has performed and documented:

PDF page 576 / M26

INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
OPERATIONS OF THE BREAST
                                                                        Asst       Surg       Anae
          a.extensive undermining for local advancement flaps >10cm to obliterate inferior or lateral
            excess flap deformities associated with simple mastectomies, or
          b.modified M-plasty or fishtail closure
       Note:
       Skin grafts are not eligible for payment in addition to R117.
     [Commentary:
     For patients who have been approved by OHIP for mastectomy related to sex-reassignment
     surgery, the following fee codes may apply for mastectomy depending on the technique:
     1.R108 - Mastectomy simple + R120 for nipple preservation and grafting.]
# R109 Mastectomy, radical or modified radical (with or without biopsy) 6      780.00      7
     [Commentary:
     Skin grafts are eligible for payment in addition to R109.]
    Mastectomy - male (benign)
      Unilateral - for treatment of adolescent gynecomastia, gynecomastia secondary to endocrine or
      genetic disorders (e.g. Klinefelter's Syndrome) or chemotherapy. Prior approval is not required.
      Removal of male breast fat tissue by liposuction is not an insured service.
# R146 - simple ................................................................................. 6 177.50 7
# R147 - subcutaneous with nipple preservation ..............................                     6 273.95 7
    Mastectomy - male
      Unilateral - for treatment of pathological male breast disease (with or without biopsy), e.g.
      carcinoma
# R148 - simple ................................................................................. 6 311.95 7
# R149 - subcutaneous with nipple preservation ..............................                     6 273.95 7
# E505     - with limited axillary node sampling, to R148 or R149 add                               178.05
    Oncoplastic Breast Surgery
# R102 Level 1 oncoplastic breast conserving lumpectomy or partial
           mastectomy for malignancy................................................             6 350.00 7
# R158 Level 2 oncoplastic breast conserving lumpectomy or partial
           mastectomy for malignancy................................................             6 547.45 7
# E505    - with limited axillary node sampling, to R102, R158 or
             R159 .......................................................................... add   178.05
# E525    - after localization with mammographic wire or radioactive
             seeds, to R102, R158 or R159 .................................. add                    48.05
# E546     - with axillary node dissection up to the level of the axillary
             vein, to R102, R158 or R159 ...........................................               388.75
# R159 Level 3 oncoplastic breast conserving lumpectomy or partial
           mastectomy for malignancy................................................             6 701.15 7
      Payment rules:
      1.R102 is only eligible for payment when
         a.resected breast volume is <= 15% of ipsilateral breast parenchyma, and
         b.the operative report documents dual plane undermining and lumpectomy defect closure
      2.R102 includes nipple undermining, nipple-areolar complex elevation or centralization, skin
        resection and glandular advancement if performed.

Master, record 1202. Record Layout PDF, page 1.

E50520250401999999990000178050000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.