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M110
M110 – Chest wall - pleura - open
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Open surgical repair of the chest wall or pleura. The fee for this service is determined by Independent Consideration (IC) by a medical consultant. Claims must be submitted with a supporting letter explaining the amount of the fee claimed, including an appropriate operative report and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule. See for details on IC claims.
When to Use
- Use M110 for open surgical repair of the chest wall or pleura that does not fall under specific fixed-fee codes like M109, requiring Independent Consideration (IC) due to the unique nature of the repair.
- Select M110 when performing complex, non-standardized open thoracic wall reconstructions or pleural procedures where the scope of work significantly exceeds standard procedural definitions.
Common Pitfalls
- Failure to include a detailed operative report and a formal letter of justification comparing the procedure's complexity to a similar fixed-fee code will result in automatic rejection or a default payment reduction.
- Billing M110 without explicitly documenting the 'Independent Consideration' rationale in the claim submission often leads to the claim being processed at a minimal or incorrect value by the medical consultant.
- Overlooking the 85% rule for secondary procedures when M110 is performed alongside other surgical interventions during the same operative session.
Billing Tips
- When drafting your IC letter, explicitly reference a specific fixed-fee code (e.g., M109) and quantify the additional time, technical difficulty, or risk factors that justify a higher fee for M110.
- Ensure the operative report clearly highlights the specific anatomical challenges or unique reconstructive techniques used, as the medical consultant relies solely on this documentation to determine the IC value.
No fee information available.
Category
P. Respiratory Surgical Procedures
Subcategory
RESPIRATORY SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Respiratory Surgical Procedures
(see General Preamble )
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