M132 – Repair of ruptured diaphragm or plication of diaphragm by thoracic approach
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Surgical procedure for the repair of a ruptured diaphragm or the plication (folding) of the diaphragm, performed via a thoracic (chest) approach. As per the Surgical Preamble (:529), the fee for this service includes pre-operative care for 1-2 days prior to surgery and post-operative care for up to two weeks, excluding the first and second post-op visits and the day of discharge visit. The service is eligible for assistant (B) and anaesthetist (C) services, with fees calculated based on basic units plus time units. The assistant's service has 9 basic units and the anaesthetist's service has 13 basic units.
When to Use
- Use M132 for the surgical repair of a traumatic diaphragmatic rupture when the thoracic approach is the primary surgical route.
- Use M132 for the plication of a paralyzed or eventrated diaphragm performed via thoracotomy, distinguishing it from abdominal approaches (e.g., M133).
- Use M132 when the procedure is performed as a standalone thoracic surgery, as it is not intended for use with abdominal-based diaphragmatic repairs.
Common Pitfalls
- Billing M132 for an abdominal approach; ensure the surgical approach matches the code definition, as abdominal repairs may fall under different codes like M133.
- Failure to account for the 14-day post-operative period; billing routine follow-up visits within this window will result in automatic rejections.
- Incorrectly billing for a second assistant without prior authorization; M132 only covers one assistant by default, and a second requires a formal letter of justification to a medical consultant.
Billing Tips
- If performing multiple procedures during the same anesthesia, remember that the major procedure (M132) is paid at 100%, while secondary procedures are subject to the 85% rule per the Surgical Preamble.
- Always document the specific thoracic approach used in the operative report to defend against potential audits regarding the choice of M132 versus abdominal diaphragmatic codes.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
Payment for a second assistant requires authorization by a medical consultant and submission of a letter from the surgeon outlining the reason.
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