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S010
S010 – Wedge resection of lip with plastic repair
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Wedge resection of lip with plastic repair. This is a surgical procedure listed in the Digestive System section of the Schedule of Benefits. As a surgical service, it includes pre-operative and post-operative care as outlined in the General Preamble. The amount payable for an anaesthesiologist (suffix C) is based on a combination of basic units and time units, with 6 basic units as per page . A surgical assistant (suffix B) is not eligible for separate payment for this procedure.
When to Use
- Use S010 for a full-thickness wedge resection of the lip to excise a lesion, which inherently includes the subsequent plastic repair to close the defect.
- Use S010 when the procedure is limited to the lip; do not use this code if the resection extends significantly into the cheek or requires a complex flap reconstruction, which may be better represented by S011 or other plastic surgery codes.
Common Pitfalls
- Billing S010 in addition to a minor procedure code like Z504 for the same lesion is considered unbundling and will lead to claim rejection.
- Attempting to bill a surgical assistant fee (suffix B) is a common error; S010 is not eligible for assistant payment per the Schedule of Benefits.
- Failing to account for the global surgical period; as a surgical service, all routine post-operative follow-up visits are included in the fee and cannot be billed separately.
Billing Tips
- If the procedure is performed on an emergency basis after hours, ensure you apply the appropriate E409 or E410 premium to the base fee to maximize reimbursement.
- Always verify the patient's age at the time of the procedure, as the age premiums (e.g., under 16 years) are automatically applicable to this surgical code and significantly increase the total payout.
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