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S012
S012 – Lip shave vermilionectomy
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Lip shave vermilionectomy is a surgical procedure to excise the vermilion border of the lip. As a surgical procedure, it includes the common and specific elements applicable to surgical services. The fee is payable to the surgeon performing the procedure (suffix A). Fees for a surgical assistant (suffix B) and anaesthetist (suffix C) are calculated separately based on basic and time units.
When to Use
- Use S012 specifically for the surgical excision of the vermilion border of the lip, typically for actinic cheilitis or pre-malignant lesions.
- Choose S012 over simple excision codes like S010 or S011 when the procedure involves the formal surgical shave and advancement of the mucosal flap for the entire vermilion.
Common Pitfalls
- Billing S012 in conjunction with a biopsy code (e.g., Z504) is often rejected as the biopsy is considered an inherent component of the surgical excision.
- Attempting to bill S012 alongside a separate closure code is incorrect, as the surgical fee for S012 includes the standard closure of the site.
Billing Tips
- Ensure the pathology report clearly supports the diagnosis of a condition requiring a full vermilionectomy to justify the use of S012 over a minor lesion excision.
- If the procedure is performed after hours, ensure you append the correct E-code (E409 or E410) to the claim to receive the appropriate percentage premium on the $225.00 base fee.
Provider Fee$225.00
Surgical Assistant Fee$75.06
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
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