M156 – Repeat lung transplant (one lung)
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Repeat surgical implantation of one lung. The service includes all specific elements of a surgical procedure as defined in the -, including pre-operative care (visits 1-2 days prior to surgery), the operation itself, and post-operative care for up to two weeks. The surgical benefit includes generally accepted components and repair of iatrogenic complications. A major pre-operative visit (consultation or assessment) is claimable separately.
When to Use
- Use M156 for the repeat surgical implantation of a single lung in a patient who has previously undergone a lung transplant.
- Use this code specifically for the surgical procedure itself; ensure the major pre-operative assessment is billed separately as a consultation or assessment code.
Common Pitfalls
- Billing for routine post-operative visits within the 14-day global period, which are already included in the M156 fee; only C124 is permitted for the discharge day.
- Attempting to bill a hospital admission assessment by the surgeon as a separate visit, which is explicitly disallowed unless it serves as the major pre-operative assessment.
- Failing to secure prior authorization for a second surgical assistant, as M156 is not on the pre-approved list for multiple assistants.
Billing Tips
- Ensure that any non-elective procedures performed during the same hospitalization for a new, unrelated condition are billed at 100% to avoid incorrect 15% reductions.
- Apply after-hours premiums E409 or E410 to the M156 fee when the procedure is non-elective and commences within the specified time windows.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
Claims Submission for Transplant Surgery: For a transplant donor, submit claims using the donor's OHIP number. If the donor is from out-of-province/country, or the Ontario donor's number is unavailable, use the recipient's Ontario health insurance number. For the transplant recipient, submit claims using the recipient's health insurance number. (See ).
Surgical Assistant (B Suffix): The fee is calculated based on 24 basic units plus time units. See - for unit calculation rules. After-hours premiums E409 (50%) and E410 (75%), and special visit premiums may apply.
Anaesthetist (C Suffix): The fee is calculated based on 40 basic units plus time units. See - for unit calculation rules. After-hours premiums E409 (50%) and E410 (75%), special visit premiums, and extra units for patient complexity (e.g., age, weight, ASA status) may apply (see ).
Second Assistant: A second assistant's service requires authorization by a medical consultant as M156 is not on the pre-approved list. (See ).
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