M031 – Rhinoplasty for reconstruction of cleft lip - nasal deformity - tip and septum reconstruction to include minor lip repair
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
The listed benefit for this procedure includes the following elements, as outlined in the Surgical Preamble (, ): * Pre-operative Care: Supervising the preparation of and/or preparing the patient for the procedure(s). * Surgical Procedure: Performing the procedure(s), by any method, or assisting another physician in the performance of the procedure and carrying out appropriate recovery room procedures, being responsible for the transfer of the patient to the recovery room, ongoing monitoring and detention during the immediate post-operative and recovery period. This includes repair of any iatrogenic complications occurring during the course of the surgery performed by the same surgeon. * Post-operative Care: Making arrangements for any related assessments or procedures, including obtaining any specimens from the patient and interpreting the results where appropriate. Making or supervising the making of arrangements for follow-up care, and post-procedure monitoring of the patient’s condition, including intervening, until the first post-operative visit. Routine post-operative care and visits for up to two weeks following surgery. The first two post-operative visits and the discharge visit (C124) are payable separately. Special visits required post-operatively are also payable separately. * Major Pre-operative Visit: The consultation or assessment where the decision to operate is made is payable separately, regardless of the time interval between this visit and the surgery. See Surgical Preamble (, ) for full details. * Patient Communication: Discussion with, providing any advice and information, including prescribing therapy, to the patient or patient’s representative, whether by telephone or otherwise, on matters related to the service. * Resources: Providing premises, equipment, supplies and personnel for the specific elements.
When to Use
- Use M031 specifically for secondary rhinoplasty procedures addressing nasal tip and septal deformities in patients with a history of cleft lip repair.
- Select M031 when the surgical plan includes both structural nasal reconstruction and minor revision of the lip scar or tissue deficiency.
Common Pitfalls
- Billing M031 alongside other nasal procedures without applying the 85% reduction rule for secondary procedures performed under the same anesthesia.
- Failing to append the E642 add-on code when the procedure is explicitly performed via an external approach with columellar and rim incisions.
Billing Tips
- Always ensure the operative report clearly documents the specific involvement of both the nasal tip and septum to justify the use of M031 over simpler nasal repair codes.
- Remember that routine post-operative care for 14 days is included in the fee, so do not bill for standard follow-up visits within this window.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
The surgical benefit includes the generally accepted surgical components of the procedure.
If the operation is cancelled after surgery has commenced but prior to its completion, the service is eligible for payment under independent consideration (R990). Submit the claim with an operative report for review.
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