S030 – Closure of fistula - anterior alveolar
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
S030A is a surgical procedure for the closure of an anterior alveolar fistula. As a surgical service, it includes all common and specific elements for surgery as outlined in the General Preamble (-), such as pre-operative evaluation, the procedure itself, and normal post-operative care. This service can be billed by the surgeon (suffix A), an assistant (suffix B), and an anaesthesiologist (suffix C). The fees for assistant and anaesthesiologist are calculated based on base units plus time units.
When to Use
- Use S030A for the surgical repair of an oro-antral or oro-nasal fistula involving the anterior alveolar ridge.
- Select this code when performing a formal flap closure (e.g., buccal advancement or palatal rotation flap) specifically for an anterior alveolar fistula.
Common Pitfalls
- Do not bill S030A in addition to a simple tooth extraction (e.g., Z181) if the fistula closure is considered an integral part of the extraction procedure.
- Avoid billing S030A for minor soft tissue debridement that does not involve a formal surgical closure of a confirmed fistula tract.
- Ensure the diagnosis code reflects the specific fistula site, as generic dental codes may lead to manual review or rejection.
Billing Tips
- When billing S030B or S030C, ensure the claim includes the mandatory base units of 6 along with the documented time units to avoid automatic rejection.
- If the procedure is performed on a patient under 16, remember to apply the appropriate age-based premium to the base fee to maximize the claim value.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
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