M101 – Tracheal-bronchial rupture, transthoracic
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Repair of a tracheal-bronchial rupture via a transthoracic approach. This is a major surgical procedure typically performed in a hospital setting under general anaesthesia. The fee for this service includes the pre-operative care (visits 1-2 days before surgery) and post-operative care for up to two weeks, with the exception of the first two post-operative visits which are separately billable. It also includes all common and specific elements of a surgical service as defined in the Schedule of Benefits.
When to Use
- Use M101 specifically for the surgical repair of a tracheal or bronchial rupture when the approach is transthoracic.
- Use this code for traumatic or iatrogenic airway ruptures requiring open surgical intervention, ensuring the approach is documented as transthoracic rather than cervical (M099).
Common Pitfalls
- Billing for routine pre-operative visits occurring 1-2 days before surgery, as these are included in the M101 fee.
- Attempting to bill for post-operative care within the 14-day global period, forgetting that only the first two post-operative hospital visits are separately billable.
- Failing to document the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium.
Billing Tips
- Ensure you bill the first two post-operative hospital visits using the appropriate subsequent visit fee code, as these are the only visits excluded from the M101 global fee.
- If performing multiple procedures under the same anaesthesia, bill the major procedure at 100% and secondary procedures at 85% to comply with the multiple procedure rule.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures, Respiratory Surgical Procedures
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