M028 – Dilation of choanal atresia
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Represents a surgical procedure on the musculoskeletal system. As a non-Independent Operative Procedure (IOP), the surgical benefit includes pre-operative care for 1-2 days before surgery and post-operative care for up to two weeks after the procedure. The major pre-operative visit (consultation or assessment) where the decision for surgery is made is separately billable. If a surgical benefit is less than the corresponding consultation benefit for a referred case, the physician may claim the consultation fee using the surgical procedure code, but no other claims for pre/post-operative care can be made. Benefits are for unilateral procedures unless specified otherwise.
When to Use
- Use M028 for the mechanical dilation of a choanal atresia membrane or stenosis in a pediatric patient.
- Use this code when the procedure is performed as a standalone surgical intervention rather than as part of a more complex reconstructive surgery.
Common Pitfalls
- Billing a hospital admission assessment or daily hospital visits during the 14-day post-operative period, as these are included in the M028 surgical benefit.
- Failing to bill the major pre-operative consultation separately, which is permitted and encouraged even if the surgery occurs on the same day.
Billing Tips
- If the surgical fee for M028 is lower than the applicable consultation fee for a referred patient, bill the consultation fee using the M028 code to ensure proper compensation without exhausting your annual consultation limit.
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.
The hospital or day care admission assessment (consultation, repeat consultation, general or specific assessment or re-assessment, partial assessment) may not be claimed by the surgeon unless it happens to be the major pre-operative visit as defined above.
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