R102

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.

PDF page 577 / M27

INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
 OPERATIONS OF THE BREAST
                                                                             Asst      Surg      Anae
         3.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.
         4.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.
         5.R159 is only eligible for payment when
              a.resected breast volume exceeds 25% of ipsilateral breast parenchyma, and
              b.the operative report documents the use of reduction mammoplasty techniques sufficient
                to achieve cosmesis.
         6.R159 include glandular pedicles coupled with large mobilizations, transpositions, and
            rotations of residual breast tissue if performed.
         7.R102, R158 or R159 are not eligible for payment when
              a.additional ipsilateral breast reconstructive procedure(s) are performed on the same day
                by a second surgeon, or
              b.the procedure is part of a pre-planned staged breast reconstruction.
         8.R143 is not eligible for payment on the same day as R102
         [Commentary:
         It is anticipated that contralateral balancing procedures will not be required when R102 is
         performed.]

Master, record 4358. Record Layout PDF, page 1.

R10220260401999999990000350000000000774600000000000000000111720000001117200

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.