S015 – Complex reconstruction or revision of previous repair and excision
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Complex reconstruction or revision of a previous repair and excision. As this service is designated for Independent Consideration (IC), the fee is not listed and must be assessed by a medical consultant. Claims for S015 must be submitted with a supporting letter explaining the amount of the fee claimed, an appropriate operative or consultation report, and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule. See for full IC requirements.
When to Use
- Use for secondary or tertiary cleft lip revisions where the anatomical complexity significantly exceeds the scope of standard primary repair codes like S013 or S014.
- Use when performing extensive tissue rearrangement or complex scar revision following a failed previous repair that requires specialized surgical techniques beyond routine closure.
Common Pitfalls
- Submitting the claim without a detailed operative report or a comparative letter will result in an automatic rejection or a request for further information by the medical consultant.
- Attempting to bill S015 alongside M030, M031, or M032 is strictly prohibited and will trigger a claim rejection due to the explicit restriction in the Schedule of Benefits.
- Failing to explicitly justify the fee amount by comparing the procedure's difficulty to non-IC codes in the Schedule often leads to lower-than-expected manual assessments.
Billing Tips
- When drafting your supporting letter, explicitly reference the specific non-IC codes you are using as a baseline for complexity to help the medical consultant understand the relative value of the work performed.
No fee information available.
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Claims for services listed as Independent Consideration (IC) must be submitted with a supporting letter explaining the amount of the fee claimed, and must include an appropriate operative or consultation report, and a comparison of the scope and difficulty of the procedure in relation to non-IC procedures in the Schedule.
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