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S013
S013 – Cleft lip - unilateral
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This procedure involves the surgical reconstruction of a unilateral cleft lip. This service is eligible for an add-on payment when performed with nasal cartilage realignment using E501. As a surgical procedure, payment is calculated based on basic and time units for both the assistant and anaesthetist.
When to Use
- Use S013 for the primary surgical repair of a unilateral cleft lip when no other complex reconstructive codes are required.
- Use S013 in conjunction with E501 when the procedure specifically includes the concurrent realignment of nasal cartilage.
Common Pitfalls
- Submitting S013 with M030, M031, or M032 will result in an automatic claim rejection due to explicit billing restrictions.
- Failing to document the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium will lead to audit recovery.
Billing Tips
- Always apply the appropriate age-based premium (e.g., under 30 days, under 1 year) to the S013 fee to ensure maximum reimbursement for pediatric patients.
- Ensure E501 is billed on the same claim as S013 to trigger the flat-fee add-on payment for nasal cartilage realignment.
Provider Fee$363.30
Surgical Assistant Fee$75.06
Anaesthetist Fee$123.92
Non-Anaesthetist Fee$123.92
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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