M138 – Hilar lymph node or lung biopsy with full thoracotomy
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Hilar lymph node or lung biopsy with full thoracotomy is a surgical procedure to obtain tissue samples for diagnosis. This service is not an Independent Operative Procedure (IOP) and its fee includes the associated pre-operative and post-operative care as defined in the Surgical Preamble (see ), such as pre-operative hospital visits 1 or 2 days prior to surgery and post-operative care for up to two weeks (excluding the first two post-operative visits). The major pre-operative visit where the decision to operate is made can be billed separately.
When to Use
- Use M138 for open thoracotomy procedures specifically intended for the biopsy of hilar lymph nodes or lung tissue.
- Use this code when the procedure requires a full thoracotomy, distinguishing it from less invasive diagnostic procedures like thoracoscopy (e.g., M142 or M143).
Common Pitfalls
- Billing for routine pre-operative hospital visits occurring 1 or 2 days prior to the surgery, as these are included in the M138 fee.
- Billing for standard post-operative care within the 14-day window, failing to recognize that the first two post-operative visits are the only ones billable separately.
- Attempting to bill M138 as an Independent Operative Procedure (IOP), which it is not, leading to potential conflicts with other surgical claims.
Billing Tips
- Ensure the major pre-operative consultation where the decision to operate was finalized is billed separately, as it is excluded from the M138 global surgical fee.
- When performing multiple procedures during the same hospitalization, apply the 85% reduction rule for secondary procedures as per the Surgical Preamble.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
This procedure is not a 'Z' code. The surgical fee includes pre-operative hospital visits which take place 1 or 2 days prior to surgery, and post-operative care and visits associated with the procedure for up to two weeks post-operatively, except for the first and second post-operative visits.
When a second assistant is required, the service is only eligible for payment following authorization by a medical consultant and requires submission of a letter from the surgeon outlining the reason.
Anaesthesia extra units for patient age, BMI, position, malignant hyperthermia risk, ASA status, and emergency status may be applicable as per .
Age-based premiums for patients under 16 years of age are applicable to the surgeon and assistant fees as per .
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