R155

PDF page 569 / M19

INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
 SKIN AND SUBCUTANEOUS TISSUE
                                                                                                    Asst   Surg     Anae
       D. Myocutaneous, myogenous or fascia-cutaneous flaps
     Note:
     To include closure of donor site defect by any means.
# R005 Sterno-mastoid, tensor fascia lata, gluteus maximus, gracilis,
          sartorius, rectus femoris, gastrocnemius (medial and
          lateral), trapezius................................................................        6     545.00    6
# R006 Pectoralis major ...................................................................... 6 734.95              6
# R155 Latissimus dorsi or unilateral rectus abdominus.....................                    6 734.95              6
     Note:
     R006 is not eligible for payment for post-mastectomy breast reconstruction.
# R008 Lower transverse rectus abdominus flap ................................                       6     984.55    8
      Repair of abdominal defect
# Z196 - different surgeon ................................................................                377.65
# E523   - same surgeon, to other procedure............................. add                               321.00
# R009 Myocutaneous - osseous flaps e.g. pectoralis major
         myocutaneous flap with rib graft, trapezius flap with scapula
         spine...................................................................................    6     783.40    8
# R007 Other - (see General Preamble GP12) ...................................                      I.C    I.C      I.C
       SKIN GRAFTS
    A. Split thickness grafts (for burn grafts see pages M10 & M11)
# R084 Very minor, very small areas, e.g. trauma ..............................        92.30 7
# R085 Minor, medium sized areas, e.g. small or skin ulcer, breast, etc             6 140.25 6
# R086 Intermediate, large areas, e.g. trunk, arms, legs ....................       6 259.10 7
# R087 Major, complex areas, e.g. face, neck, hands ........................        6 388.00 7
# R088 Extensive major, very large area(s) ........................................ 6 567.95 6
     Note:
     The medical record must demonstrate the appropriateness of code claimed relative to size.

PDF page 578 / M28

Post-mastectomy breast reconstruction
  # R119 Breast mound creation by prosthesis as sole procedure........                                         6         350.00          7
  # R118 Breast skin reconstruction by local flaps or grafts, includes
           Wise pattern skin flaps and de-epithelialized skin flaps .....                                      6         405.60          6
  # E529   - with breast mound creation by prosthesis, to R118 ... add                                                   102.45
  # R156 Breast mound creation by insertion of tissue expander,
           includes creation of submuscular pocket ...........................                                 6         425.00          6
  # E513   - breast mound creation by soft tissue, includes flap
             insetting and shaping for autogenous reconstruction, to
             R118, R125, R064, R008 or R155 ............................. add                                            297.50
  # E514   - immediate breast reconstruction following mastectomy, to
             R125, R064, R156, R008, R118, or R155 ................. add                                                 200.00
                                          Note:
                                          1.Z132 is not eligible for payment with R156.
                                          2.E513 is not eligible for payment with E529.
                                          3.E514 is only eligible for payment if post-mastectomy breast reconstruction is performed
                                            immediately following mastectomy during the same anaesthesia.
  # R114 Revision of breast mound .......................................................                     6          230.30          7
  # R120 Nipple-areola reconstruction by grafts and/or flaps ................                                 6          300.00          7
  # R142 Nipple-areola tattooing - unilateral..........................................                       nil        175.00          nil
  # R143 Contralateral balancing mastopexy or reduction, to include
           nipple transplantation or grafting, if rendered.....................                                6         472.15          6
  # R144 Contralateral balancing augmentation mammoplasty.............       6        350.00       6
       Note:
       1.R143 and R144 are only eligible for payment when performed for post-mastectomy breast
         reconstruction. Prior authorization of payment from the Ministry of Health is not required.
                                          2.R110 and R112 are not eligible for payment with R143 or R144.
                                          [Commentary:
                                          1.For reduction or augmentation mammoplasty performed for reasons other than a balancing
                                            procedure related to post-mastectomy breast reconstruction, see R110 and R112
                                            respectively. Prior authorization of payment from the ministry is required.
                                          2.See the applicable service for post-mastectomy breast reconstruction by myocutaneous
                                            flaps or free flaps.]
      Reduction mammoplasty and augmentation mammoplasty (other than post-mastectomy
      breast reconstruction)
  # R110 Reduction mammoplasty (female, to include nipple
            transplantation or grafting, if rendered) - unilateral ............ 6 472.15 7
  # R112 Augmentation mammoplasty - unilateral ................................ 6 350.00 7

Master, record 4410. Record Layout PDF, page 1.

R15520260401999999990000734950000000774600000000000000000095760000000957600

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.