M023 – External or transantral ethmoidectomy - unilateral
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
External or transantral ethmoidectomy is a unilateral surgical procedure. The service includes a Caldwell-Luc with a transantral approach. In addition to the common and specific surgical elements outlined in the Surgical Preamble (, ), the fee for this non-Z code procedure includes:
- Pre-operative hospital visits which take place 1 or 2 days prior to surgery.
- Post-operative care and visits associated with the procedure for up to two weeks post-operatively (excluding the first and second post-operative visits in hospital and the day of discharge visit C124).
- The major pre-operative visit (e.g., the consultation or assessment where the decision to operate is made).
When to Use
- Use M023 for a unilateral external ethmoidectomy performed via an external incision or a transantral approach.
- Use this code when performing a Caldwell-Luc procedure via a transantral approach, as the fee for M023 explicitly includes this technique.
Common Pitfalls
- Billing for post-operative visits within the 14-day global period is a common audit risk, as these are included in the M023 fee.
- Attempting to bill a separate consultation fee for the decision to operate is incorrect, as the major pre-operative assessment is included in the M023 surgical fee.
Billing Tips
- Ensure that hospital visits occurring 1 or 2 days prior to the surgery are not billed separately, as they are bundled into the M023 procedural fee.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
Anaesthesia (suffix C) base units are 10. Assistant (suffix B) base units are 6.
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