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M064
M064 – External transethmoidal sphenoid sinusectomy
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
M064 is a surgical procedure for an external transethmoidal sphenoid sinusectomy. The fee for this service includes pre-operative care for 1-2 days prior to surgery and post-operative care for up to two weeks, with some exceptions for separately billable visits as per the Surgical Preamble (:529). The major pre-operative visit (consultation or assessment) is claimable separately (:530).
When to Use
- Use M064 when performing an external approach to the sphenoid sinus via an ethmoidectomy, typically for chronic sphenoiditis or removal of a sphenoid sinus mucocele.
- Select M064 when the surgical intent is a formal external transethmoidal sphenoid sinusectomy, distinguishing it from endoscopic procedures which fall under different fee codes.
Common Pitfalls
- Billing M064 in conjunction with other sinus procedures without applying the 85% reduction rule for secondary procedures performed under the same anaesthesia.
- Attempting to bill routine post-operative follow-up visits within the 14-day post-operative period, as these are included in the M064 fee.
Billing Tips
- Ensure the major pre-operative consultation or assessment is billed separately using the appropriate consultation code, as this is explicitly permitted under SP2:530.
- If the procedure is performed after hours, ensure the claim includes the correct E-prefix premium (E409 or E410) to avoid missing the 50% or 75% procedural fee increase.
Provider Fee$612.65
Surgical Assistant Fee$87.57
Anaesthetist Fee$154.90
Non-Anaesthetist Fee$154.90
Effective: April 1, 2025
Category
P. Respiratory Surgical Procedures
Subcategory
RESPIRATORY SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Respiratory Surgical Procedures
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