M135 – Major decortication of lung for empyema or tumour
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Major decortication of lung for empyema or tumour. This is a surgical procedure involving the removal of a fibrinous peel or restrictive membrane from the visceral pleura to allow for lung re-expansion. 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, with specific exceptions for post-operative visits (see billingInteractions.restrictionNotes).
When to Use
- Use M135 for the surgical removal of a restrictive fibrinous peel or membrane from the visceral pleura in cases of chronic empyema.
- Use M135 for major decortication performed to address lung restriction caused by malignant pleural involvement or tumor-related pleural thickening.
Common Pitfalls
- Billing for routine post-operative hospital visits within the 14-day global period, which are already included in the M135 fee.
- Failing to exclude the first and second post-operative hospital visits from the global period, which are the only exceptions payable at the specialty-specific subsequent visit fee.
- Attempting to bill a second surgical assistant without prior authorization, as M135 is not on the pre-approved list for a second assistant.
Billing Tips
- Ensure the major pre-operative consultation or assessment is billed separately from the M135 procedure, as this visit is not included in the surgical benefit.
- If the patient is discharged before the 14-day post-operative window, remember that the day-of-discharge visit is billable using code C124.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
A second assistant's service requires authorization by a medical consultant with a letter from the surgeon outlining the reason the second assistant was required, as M135 is not on the pre-approved list for a second assistant. See .
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