M058 – Radical frontal sinusectomy for tumour, radical exenteration of disease with drill out for access, or ostium revision
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Radical frontal sinusectomy for a tumour, radical exenteration of disease with drill out for access, or ostium revision. As a surgical service not listed with a 'Z' code, the fee for this service includes pre-operative hospital visits taking place 1 or 2 days prior to surgery, and post-operative care and visits for up to two weeks following the procedure for a hospital in-patient. Exceptions to the included post-operative care are the first and second post-operative visits (which are payable at the specialty-specific subsequent visit fee) and a subsequent visit by the Most Responsible Physician on the day of discharge (C124).
When to Use
- Use M058 for radical frontal sinusectomy specifically for the management of a tumour.
- Use M058 for radical exenteration of disease involving a drill-out procedure to gain surgical access.
- Use M058 for revision of the frontal sinus ostium when the complexity meets the definition of a radical procedure.
Common Pitfalls
- Billing M058 for a simple frontal trephine, which is specifically excluded and should be billed as Z318.
- Attempting to bill routine post-operative hospital visits within the 14-day global period, which are already included in the M058 fee.
- Failing to submit the required letter from the surgeon when claiming M400B for surgical assistant services, leading to automatic rejection.
Billing Tips
- Remember that the first and second post-operative visits are billable separately at the specialty-specific subsequent visit rate, despite the 14-day global period.
- Ensure the discharge day visit is billed separately using C124 if you are the Most Responsible Physician, as this is an explicit exception to the global fee.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
[Commentary]: For frontal trephine see `Z318`.
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