M015 – Septodermoplasty
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This is a surgical procedure from the Respiratory Surgical Procedures section of the Schedule of Benefits. The specific listing for M015 is 'Septodermoplasty (to include fascial and other grafts)'. The fee for this service includes the associated pre-operative and post-operative care as defined in the Surgical Preamble. According to , this includes pre-operative hospital visits which take place 1 or 2 days prior to surgery, and post-operative care and visits associated with the procedure for up to two weeks post-operatively. Exceptions to the included post-operative care are the first and second post-operative visits in hospital (payable at the specialty specific subsequent visit fee) and the subsequent visit by the Most Responsible Physician (MRP) on the day of discharge (C124). The major pre-operative visit (the consultation or assessment where the decision to operate is made) is not included in the surgical fee and can be billed separately. A hospital admission assessment by the surgeon is not eligible for payment unless it is the major pre-operative visit as per .
When to Use
- Use M015 for the surgical correction of nasal septal perforation or mucosal deficiency requiring the harvesting and placement of fascial or other grafts.
- Use M015 when performing a septodermoplasty as a standalone procedure or as the primary component of a multi-procedure respiratory surgery session.
Common Pitfalls
- Billing a hospital admission assessment separately; this is considered part of the surgical fee unless it qualifies as the major pre-operative consultation where the decision to operate was made.
- Attempting to bill for a surgical assistant; M015 is designated with a 'nil' assistant fee in the Schedule of Benefits, meaning no assistant claim will be paid.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, which is a common cause for automated rejection.
Billing Tips
- Ensure the major pre-operative consultation is billed separately using the appropriate consultation or assessment code, as this is explicitly excluded from the M015 surgical fee.
- If the procedure is performed via an external approach using transverse columellar and rim incisions with elevation of the nasal tip skin flap, remember to append E642 to the claim to receive the additional benefit.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
The assistant fee for this service is not payable, as per the master fee record. According to , this occurs when 'nil' is listed in the 'Asst' column for the procedure in the Schedule of Benefits.
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