S021 – Repair of extensive laceration
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Repair of extensive laceration of the oral cavity or pharynx. This service is valued by Independent Consideration (IC) by OHIP medical consultants as per . Claims must be submitted with a supporting letter explaining the fee, an operative report, and a comparison to other listed procedures. Note: For minor lacerations, see the Skin section of the Schedule of Benefits.
When to Use
- Use S021 for complex, multi-layered repairs of deep oral cavity or pharyngeal lacerations that require significant surgical time and specialized instrumentation, distinguishing them from simple mucosal closures.
- Use S021 when the repair involves critical structures within the oral cavity or pharynx that necessitate a higher level of surgical expertise than standard skin laceration repairs found in the Skin section of the Schedule.
Common Pitfalls
- Submitting S021 without a detailed operative report and a comparative letter will result in automatic rejection or a request for manual review, as it is an IC (Independent Consideration) code.
- Attempting to bill S021 for minor lacerations that are appropriately covered by standard skin repair codes will lead to claim rejection; ensure the complexity of the oral/pharyngeal involvement is clearly documented.
Billing Tips
- When drafting the required comparative letter, explicitly reference the complexity of the repair by comparing it to specific, non-IC surgical codes in the Digestive System section to justify the fee claimed.
- Ensure the operative report highlights the specific anatomical structures involved and the depth of the repair to support the 'extensive' classification required for S021.
No fee information available.
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
For Independent Consideration (IC) claims, 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 must be submitted.
For the Trauma Premium (E420), the medical record must list the Injury Severity Score (ISS).
For minor lacerations - see Skin.
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