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M103
M103 – Segmental resection of trachea with either sternotomy or thoracotomy
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving the excision of a segment of the trachea. Access to the trachea for this procedure is gained either through a thoracotomy (an incision into the pleural space of the chest) or a sternotomy (an incision through the sternum). This procedure is eligible for surgeon (A suffix), assistant (B suffix), and anaesthesia (C suffix) services, with specific base units assigned for assistant (9) and anaesthesia (13) services as per the Schedule of Benefits.
When to Use
- Use M103 for formal tracheal resection and reconstruction requiring formal thoracotomy or sternotomy access, distinguishing it from endoscopic procedures like M099.
- Select M103 when the surgical intent is the excision of a tracheal segment, as opposed to M104 which covers tracheal reconstruction without resection.
Common Pitfalls
- Billing M103 in conjunction with endoscopic airway procedures performed during the same session often triggers manual review or rejection; ensure clinical necessity for both is documented.
- Failure to document the specific approach (thoracotomy vs. sternotomy) can lead to audit discrepancies, as the code definition explicitly mandates one of these two access methods.
Billing Tips
- If the procedure is a repeat operation performed more than 30 days after the initial surgery, remember to add code E623 to your claim to capture the additional fee.
- Always verify the start time of the procedure to apply the correct after-hours or overnight premium (E409A/E410A), as these are calculated based on the case commencement time.
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