M020 – Repair of choanal atresia
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
The service M020 is a surgical procedure listed in the P. Respiratory Surgical Procedures section of the OHIP Schedule of Benefits. This procedure involves the repair of choanal atresia, which can be unilateral or bilateral. General surgical rules from the Surgical Preamble (pages -) apply.
When to Use
- Use M020 for the surgical correction of congenital choanal atresia, whether the obstruction is bony or membranous.
- Use M020 for both unilateral and bilateral repairs, as the code is not specified by laterality.
Common Pitfalls
- Do not bill for hospital admission assessments or pre-operative visits occurring 1-2 days before surgery, as these are bundled into the M020 fee.
- Do not bill for routine post-operative care within the 14-day period, except for the first and second post-operative visits or the day of discharge (C124).
- Avoid billing a consultation fee in addition to M020 if the consultation was the major pre-operative visit where the decision to operate was finalized.
Billing Tips
- Ensure you apply the appropriate Age-Based Fee Premium (e.g., AGE_PREMIUM_LT30D or AGE_PREMIUM_LT1Y) as pediatric patients are the most common recipients of this procedure.
- If the surgery is non-elective and performed after hours, ensure you append the correct E-code (E409A or E410A) to the M020 claim to receive the 50% or 75% procedural premium.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
The surgical benefit does not include the major pre-operative visit - i.e. the consultation or assessment fee which may be claimed when the decision to operate is made and the operation is scheduled, regardless of the time interval between the major pre-operative visit and surgery. (See )
If the surgical benefit is less than the surgical consultation benefit, and the case is referred, a physician may claim a surgical consultation benefit instead of the surgical benefit. However, to avoid the consultation being counted as such under the Ministry of Health limitation rules on the number of consultations allowed per year, the physician should claim the consultation fee under the surgical procedure nomenclature or code. Since the consultation is replacing a procedural benefit which includes the pre- and post-operative and surgical care, no additional claims beyond the consultation should be made. (See )
If the surgeon is required to perform a service(s) not usually associated with the original surgical procedure, he/she may claim for these on a fee-for-service basis. (See )
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