M011 – Excision of other intranasal lesions
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
#M011 is for the excision of other intranasal lesions. As this service is designated for Independent Consideration (IC), claims must be submitted with a supporting letter explaining the fee, an operative report, and a comparison to other non-IC procedures as described on page of the Schedule. The '#' prefix indicates that for services performed in a hospital, the premises, equipment, supplies, and personnel are funded by the hospital's global budget.
When to Use
- Use M011 for the excision of intranasal lesions that do not have a specific, non-IC code assigned in the Schedule, such as non-specific polyps or benign intranasal masses.
- Select M011 when the procedure involves a more complex excision than simple cautery or biopsy, provided the specific lesion type is not covered under codes like R031 or R032.
Common Pitfalls
- Failing to include a detailed operative report and a comparative analysis to a non-IC procedure (e.g., comparing the complexity to a standard R031) will result in an automatic rejection or a significant delay in payment.
- Billing M011 for simple nasal biopsies or cauterization, which are already covered by specific, lower-value non-IC codes, will lead to audit scrutiny and potential clawbacks.
Billing Tips
- When submitting the required letter for Independent Consideration, explicitly reference the time, technical difficulty, and anatomical complexity of the excision compared to a listed procedure to justify your requested fee.
No fee information available.
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
For Independent Consideration (IC) services, claims must be submitted with a supporting letter explaining the amount of the fee claimed, and must include an appropriate operative or consultation report, and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule.
(see General Preamble )
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