S004 – Ranula
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical excision of a ranula, a mucus retention cyst that forms in the mouth, typically under the tongue, arising from a blocked or damaged salivary gland duct. The fee for this service is for the surgeon. When required, assistant and anaesthesia services are billed separately using the same code with different suffixes. Assistant services (S004B) are valued at 6 base units, and anaesthesia services (S004C) are valued at 6 base units. Time units are added to these base units as applicable.
When to Use
- Use S004 for the formal surgical excision of a ranula, which is distinct from simple incision and drainage (which may be billed under different minor surgical codes).
- Select S004 when the procedure involves the complete removal of the mucus retention cyst, typically performed in an operating room or surgical suite setting.
Common Pitfalls
- Billing S004 alongside a consultation or assessment code on the same day is a common rejection; ensure the surgical fee is billed as the primary service unless a separate, distinct clinical problem is addressed.
- Failing to append the correct suffix (B for assistant, C for anaesthesia) when billing for support services will result in automatic claim rejection for the secondary provider.
Billing Tips
- Always apply the appropriate age-based premium (e.g., 10% for patients 5-15 years old) to the S004 base fee, as these are not automatically calculated by the system.
- If the procedure is performed after hours, ensure you use the correct premium code (E409 or E410) to increase the procedural fee by 50% or 75% respectively, rather than relying on standard visit premiums.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
To include nasopharynx, oropharynx, hypopharynx except where otherwise specified.
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