M109 – Chest wall - pleura - closed
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Repair of the chest wall or pleura via a closed approach. As this service is designated for Independent Consideration (IC), claims must be submitted with a supporting letter explaining the amount of the fee claimed, an appropriate operative or consultation report, and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule (see ). The fee for the surgeon includes pre-operative and post-operative care as outlined in the Surgical Preamble ().
When to Use
- Use M109 for closed chest wall or pleural procedures that lack a specific fee-schedule code, such as minor percutaneous pleural biopsies or localized closed-approach repairs.
- Select M109 when the complexity of the closed procedure is significantly higher than standard diagnostic procedures but does not meet the criteria for an open thoracotomy (e.g., M110).
Common Pitfalls
- Submitting M109 without the mandatory supporting letter and comparative analysis will result in an automatic rejection or a request for manual review.
- Failing to explicitly reference a non-IC procedure in your letter makes it impossible for the Ministry to benchmark the value of your claim, leading to payment delays.
- Billing M109 for procedures that have an existing, defined code in the Schedule is a common audit trigger and will lead to a clawback.
Billing Tips
- When drafting your IC letter, compare the time, technical difficulty, and risk of M109 to a similar non-IC procedure like M110 to justify the requested fee.
- Ensure your operative report clearly details the closed nature of the approach to distinguish it from open surgical codes, as this is the primary determinant for the IC assessment.
No fee information available.
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
For Independent Consideration (IC) claims, submission must include a supporting letter explaining the amount of the fee claimed, an appropriate operative or consultation report, and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule.
see General Preamble
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