M067 – Closure of antral fistula - under general anaesthetic
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Closure of antral fistula under general anaesthetic, which may include a Caldwell-Luc procedure if necessary. As a non-'Z' code surgical service, the fee includes pre-operative hospital visits one or two days prior to surgery and post-operative care for up to two weeks (with the exception of the first and second post-operative visits, which are separately payable). For full details, see the Surgical Preamble (, ).
When to Use
- Use M067 for the surgical closure of an oro-antral fistula following an extraction or trauma when performed under general anaesthetic.
- Use M067 when the procedure requires a Caldwell-Luc approach to access and close the fistula, as the fee explicitly encompasses this technique if necessary.
Common Pitfalls
- Do not bill for hospital visits within the 14-day post-operative period, as these are included in the M067 fee; only the first and second post-operative visits are separately billable.
- Avoid billing M067 alongside other minor procedures without applying the 85% multiple procedure rule, which mandates that secondary procedures performed under the same anaesthetic are reduced.
Billing Tips
- If an assistant is required, you must submit a letter of justification to the Ministry to claim M400B, using the 7 base anaesthesia units as the foundation for the assistant's fee calculation.
- Always verify if the procedure qualifies for E409 or E410 premiums based on the start time, as these significantly increase the procedural fee for non-elective cases.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
This procedure has 7 basic anaesthesia units. The total anaesthesia fee is calculated based on the sum of basic and time units multiplied by the anaesthesiologist unit fee ($15.49). See and for calculation rules.
Assistant services are not explicitly listed for this procedure. If an assistant is required, the service may be claimed under M400B (Surgical Assistant) upon authorization by a medical consultant, using the anaesthesia base units (7) as the basic units for the assistant's fee calculation. A letter from the surgeon outlining the reason the assistant was required must be submitted. See .
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