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M104
M104 – Carinal resection (without pulmonary resection)
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Carinal resection (without pulmonary resection) is a surgical procedure to remove the carina, which is the cartilaginous ridge within the trachea that separates the two main bronchi. This procedure does not involve the resection of any part of the lungs. The fee for this service includes standard pre-operative and post-operative care as outlined in the Surgical Preamble ().
When to Use
- Use M104 specifically for isolated carinal resection where the bronchial anatomy is reconstructed without performing a formal lobectomy or pneumonectomy.
- Use M104 when the primary surgical objective is the management of tracheal or carinal stenosis or localized tumors that do not require lung tissue resection.
Common Pitfalls
- Billing M104 in conjunction with pulmonary resection codes (e.g., M100, M101) will trigger a 15% reduction on the lesser procedure under the multiple procedure rule; ensure the operative report clearly delineates the carinal resection as a distinct procedure if claiming full value for both.
- Failure to document the specific anatomical extent of the resection can lead to audit scrutiny, as M104 is strictly defined as excluding pulmonary resection.
Billing Tips
- If the procedure is performed on an emergency basis, ensure the appropriate After Hours Procedure Premium (E409 or E410) is linked to the claim to maximize the procedural fee.
- When M104 is performed alongside other respiratory procedures during the same operative session, verify the hierarchy of the procedures to ensure the highest-valued code is billed at 100% and subsequent procedures are correctly adjusted at 85%.
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