M157 – Donor Heart - Lung removal
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
M157 is for the surgical removal of the heart and lungs from a donor for the purpose of transplantation. This procedure is listed in both the Cardiovascular and Respiratory surgical sections of the Schedule of Benefits. It is often performed in conjunction with cardiac or cardiopulmonary transplantation procedures for the recipient, such as R870 (Orthotopic cardiac transplantation) or R874 (Cardiopulmonary transplantation). The fee for the surgeon (M157A) is a flat rate, while fees for the assistant (M157B) and anaesthetist (M157C) are calculated based on basic and time units.
When to Use
- Use M157A for the surgical procurement of heart and lungs from a deceased donor for the purpose of transplantation.
- Use this code when the surgeon is performing the organ retrieval procedure, distinct from the recipient's transplantation procedure (e.g., R870 or R874).
Common Pitfalls
- Do not bill anaesthesia add-on codes E016C, E017C, or E020C, as these are explicitly restricted when anaesthesia is rendered to a brain-dead donor for organ procurement.
- Ensure the claim is submitted using the donor's Ontario health insurance number, or the recipient's number if the donor is from out-of-province or out-of-country.
Billing Tips
- Apply after-hours premiums (E409 or E410) if the procurement procedure commences during the specified night or evening timeframes, as these are eligible for donor organ transport services.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures, Cardiovascular Surgical Procedures
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