M149 – Pleurectomy, and/or apical bullectomy for pneumothorax
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for pneumothorax. This procedure involves either the surgical removal of part of the pleura (pleurectomy), the removal of small air sacs (bullae) from the apex of the lung (apical bullectomy), or both. It is a major thoracic surgery typically performed to prevent recurrence of spontaneous pneumothorax. A 35% premium (E683A) applies if performed thorascopically, by video-assisted thoracic surgery (VATS), by robotic-assisted surgery, or by uniportal approach.
When to Use
- Use M149 for the surgical treatment of recurrent spontaneous pneumothorax via pleurectomy or apical bullectomy.
- Use M149 when performing a VATS or robotic-assisted apical bullectomy to address persistent air leaks or bullous disease.
Common Pitfalls
- Failing to append the E683A premium when the procedure is performed via VATS or uniportal approach, as this is not automatically triggered by the base code.
- Attempting to bill M149 in conjunction with other thoracic procedures without applying the 15% reduction rule for multiple procedures performed during the same operative session.
Billing Tips
- Always ensure the E683A premium is submitted on the same claim as M149 to receive the 35% increase for minimally invasive approaches.
- If the procedure is performed on an emergency basis after hours, ensure the appropriate E409 or E410 premium is applied to the base fee to maximize reimbursement.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
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