M018 – Endonasal augmentation for atrophic rhinitis - unilateral
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This billing code represents a surgical procedure on the trachea. The specific details for this service are not available in the provided context, but it is identified as a major surgical procedure eligible for the E676 morbid obesity premium. All general surgical rules from the Surgical Preamble (-) apply, including rules for pre-operative and post-operative care, multiple procedures, and billing by multiple surgeons. The service is also eligible for after-hours and trauma premiums.
When to Use
- Use M018 for unilateral endonasal augmentation procedures specifically indicated for the treatment of atrophic rhinitis.
- Use this code when performing a primary surgical intervention on the nasal mucosa or underlying structures to address atrophy, provided it does not fall under the exclusions of minor procedures.
Common Pitfalls
- Attempting to claim the E676 morbid obesity premium without documenting the patient's BMI in the permanent medical record, which is a mandatory requirement for audit compliance.
- Billing M018 alongside other nasal procedures without applying the 85% reduction rule for secondary procedures, as per the Surgical Preamble for multiple procedures under the same anaesthesia.
- Incorrectly applying the E420 trauma premium when the Injury Severity Score (ISS) is not explicitly documented in the medical record, leading to automatic claim rejection.
Billing Tips
- Ensure that if M018 is performed bilaterally, the second side is billed at 85% of the fee, adhering to the multiple procedure rules outlined in the Surgical Preamble.
- Verify that the E676 premium is only applied if the surgery is performed under general anaesthesia and the patient meets the specific BMI threshold for neck-related surgery (BMI > 45).
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
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