M021 – Puncture and insertion of tube for choanal atresia
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
The specific details for billing code M021 are available in the P. Respiratory Surgical Procedures section of the Schedule of Benefits. Puncture and insertion of tube for choanal atresia - unilateral or bilateral. General rules for surgical services, including pre-operative and post-operative care, apply as outlined in the Surgical Preamble (-). The service is eligible for surgeon (suffix A) and anaesthetist (suffix C) fees. The fee for an assistant (suffix B) is not payable.
When to Use
- Use M021 for the primary surgical puncture and tube placement in neonates or infants diagnosed with congenital choanal atresia.
- Use M021 when performing a revision or secondary puncture procedure for a previously treated choanal atresia that has restenosed.
Common Pitfalls
- Attempting to bill an assistant fee (suffix B) will result in automatic rejection, as M021 is explicitly ineligible for surgical assistant claims.
- Failing to apply the appropriate age-based premium (e.g., AGE_PREMIUM_LT30D) for neonatal patients results in significant under-billing of the surgical fee.
- Billing M021 alongside other nasal procedures without considering the 85% reduction rule for secondary procedures under the same anaesthesia as per SP3.
Billing Tips
- Ensure the procedure is coded as a surgical service; if performed in an emergency setting after hours, apply E409 or E410 to the base fee to capture the 50-75% premium.
- If the procedure is performed bilaterally, confirm that the claim reflects the single procedural fee as M021 covers both unilateral and bilateral approaches.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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.
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