M013 – Partial septorhinoplasty (excluding osteotomies)
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure as defined in the Surgical Preamble. In addition to the common elements described in -, all surgical services include the following specific elements: A. Supervising the preparation of and/or preparing the patient for the procedure(s). B. Performing the procedure(s), by any method, or assisting another physician in the performance of the procedure and carrying out appropriate recovery room procedures, being responsible for the transfer of the patient to the recovery room, ongoing monitoring and detention during the immediate post-operative and recovery period. C. Making arrangements for any related assessments or procedures, including obtaining any specimens from the patient and interpreting the results where appropriate. D. Where indicated, making or supervising the making of arrangements for follow-up care, and post-procedure monitoring of the patient's condition, including intervening, until the first post-operative visit. E. Discussion with, providing any advice and information, including prescribing therapy, to the patient or patient's representative, whether by telephone or otherwise, on matters related to the service. F. Providing premises, equipment, supplies and personnel for the specific elements. For surgical services not listed with a “Z” code, the fee also includes pre-operative care (1-2 days prior) and post-operative care (up to two weeks), with some exceptions for subsequent visits.
When to Use
- Use M013 for partial septorhinoplasty procedures that do not involve osteotomies, such as correcting a deviated septum and nasal tip refinement.
- Use M013 when the procedure involves internal nasal reconstruction that falls short of a full rhinoplasty requiring bone work.
Common Pitfalls
- Billing M013 alongside a major pre-operative visit is a common rejection; the surgical fee includes the pre-operative assessment regardless of the timing.
- Failing to obtain and document the required Ministry of Health prior authorization will result in automatic claim rejection.
- Attempting to bill M013 with osteotomies; if osteotomies are performed, the procedure must be coded as a full rhinoplasty rather than a partial one.
Billing Tips
- If performing an external approach with columellar/rim incisions, remember to add the E642 premium to your M013 claim to capture the additional complexity.
- Always ensure the 14-day post-operative period is respected, as any routine follow-up visits within this window are included in the M013 fee.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Written prior authorization by a Ministry of Health medical consultant.
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