M063 – Coronal and/or osteoplastic procedure for frontal sinusectomy, reconstruction or obliteration
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
M063 represents a coronal and/or osteoplastic procedure for frontal sinusectomy, reconstruction, or obliteration. This service can be performed on one side (unilateral) or both sides (bilateral) under a single fee code. The fee for this surgical procedure includes: - Pre-operative care and visits taking place one or two days prior to surgery. - Post-operative care and visits for up to two weeks following the procedure for a hospital in-patient, with the exception of the first and second post-operative visits (which are payable separately) and the discharge day visit (C124). For a detailed breakdown of included and excluded services, see the Surgical Preamble (, ). The major pre-operative assessment where the decision to operate is made can be claimed separately ().
When to Use
- Use M063 for definitive frontal sinus obliteration or reconstruction following chronic frontal sinusitis or trauma, as it is distinct from the simpler frontal trephine (Z318).
- Select M063 when performing an osteoplastic flap approach to the frontal sinus, regardless of whether the procedure is unilateral or bilateral.
Common Pitfalls
- Billing for post-operative visits within the 14-day global period, except for the first and second post-operative visits which are specifically exempted.
- Attempting to bill M063 as a bilateral procedure; the fee code is inclusive of both sides, so no bilateral premium or secondary procedure reduction applies.
- Failing to bill the major pre-operative assessment separately, as this is explicitly excluded from the M063 global fee.
Billing Tips
- Ensure the first and second post-operative visits are claimed using appropriate visit codes, as these are the only routine post-operative visits payable outside the global fee.
- If the procedure is non-elective and performed after hours, ensure the correct E-code (E409A or E410A) is appended to the surgeon's claim to capture the 50% or 75% premium.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
For frontal trephine see Z318.
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