S006 – Excision of lesion - over 4 cms
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of a lesion over 4 cms located in the oral cavity or pharynx (including nasopharynx, oropharynx, and hypopharynx). The service includes all common elements of insured services as outlined in the Schedule of Benefits, such as obtaining patient history, maintaining records, and arranging follow-up care. This fee is for the surgeon performing the procedure.
When to Use
- Use for the surgical excision of a lesion measuring greater than 4 cm located specifically within the oral cavity, nasopharynx, oropharynx, or hypopharynx.
- Select this code when the lesion size exceeds the threshold for S005, which covers smaller excisions in the same anatomical regions.
Common Pitfalls
- Billing S006 for lesions 4 cm or smaller, which should be billed under S005; ensure the measured size is clearly documented in the operative report to support the higher fee.
- Failing to document the specific anatomical location within the oral cavity or pharynx, which can lead to rejections if the claim is audited for site-specific eligibility.
- Attempting to bill S006 alongside other excision codes for the same site; the Schedule of Benefits generally considers the excision of a single lesion as an all-inclusive procedure.
Billing Tips
- If the procedure is performed in an office or clinic setting rather than a hospital, remember to append the E542 premium to the S006 claim to capture the additional $11.55.
- Always verify the patient's age at the time of service to ensure the appropriate age-based percentage premium (ranging from 10% to 30%) is applied, as these are not automatically calculated by the system.
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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