M014 – Septorhinoplasty
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
M014 is a surgical procedure listed in the P. Respiratory Surgical Procedures section of the Schedule of Benefits. The listed fee for the surgeon (suffix A) includes pre-operative care (visits 1-2 days prior to surgery) and post-operative care associated with the procedure for up to two weeks post-operatively, with the exception of the first and second post-operative visits which may be billed separately (). The major pre-operative assessment where the decision to operate is made can be claimed separately (). This service is eligible for anaesthesia (suffix C) and surgical assistant (suffix B) services, which are calculated based on basic and time units (, ). Multiple procedure payment rules apply ().
When to Use
- Use M014 for formal septorhinoplasty procedures where both functional septal correction and external nasal reconstruction are performed, provided written Ministry of Health prior authorization is obtained.
- Use M014 when the procedure involves significant structural modification of the nasal framework that exceeds the scope of a simple septoplasty (R319) or rhinoplasty (M012/M013).
Common Pitfalls
- Billing a consultation or assessment code on the same day as the surgery is a frequent rejection, as the M014 fee includes the pre-operative assessment unless it is the specific visit where the decision to operate was finalized.
- Attempting to bill for the first or second post-operative visit as a standard office visit will result in rejection; these must be claimed specifically as post-operative visits under the surgical rules.
- Failure to secure and document the required written Ministry of Health prior authorization prior to the procedure will lead to automatic claim denial during audit.
Billing Tips
- Ensure all applicable premiums, such as E840 (septal perforation repair) or E642 (external approach), are submitted on the same claim as M014 to ensure they are processed correctly as add-ons.
- If the surgical benefit for M014 is lower than the surgical consultation fee for a referred patient, you may claim the consultation fee instead, but you must not claim any additional surgical fees for that encounter.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Medical records must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary as per .
For services supervised under a medical trainee, specific documentation is required, including identification of the supervising physician, the trainee, a description of the service, patient consent, and evidence of supervision as per .
Written prior authorization by a Ministry of Health medical consultant is required. (Exact documentation requirements from Surgical Preamble, paragraph 17 could not be retrieved as the page/paragraph was not found).
The listed benefits are for unilateral procedures only, unless otherwise stated ().
If a physician performs a minor surgical procedure and during the same visit assesses and treats the patient for another completely unrelated and significant problem involving another body system, the physician should claim for the procedure as well as the appropriate assessment ().
The listed benefit for a procedure normally includes repair of any iatrogenic complications occurring during the course of the surgery performed by the same surgeon ().
If the operation is cancelled after surgery has commenced but prior to its completion, the service is eligible for payment under independent consideration (R990).
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