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S031
S031 – Palatal fenestration
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
S031 is a surgical procedure for palatal fenestration. It is marked with a '#' prefix, indicating that when performed in a hospital or Integrated Community Health Services Centre (ICHSC), the cost of premises, equipment, supplies, and personnel are funded through the facility's budget and are not billed separately by the physician. See for details.
When to Use
- Use S031 for the surgical creation of a palatal fenestration when performed as a primary procedure to address specific palatal pathology.
- Select S031 when the procedure is performed in an office setting, as the '#' prefix indicates that facility fees are included in the physician's payment when performed in a hospital or ICHSC.
Common Pitfalls
- Attempting to bill S031 in addition to other major palatal or pharyngeal surgical codes without clear documentation of distinct, separate procedures, which may trigger a rejection for unbundling.
- Failing to document the specific anatomical location within the nasopharynx, oropharynx, or hypopharynx, which is required to justify the use of this code under the provided notes.
Billing Tips
- Ensure that age-based premiums are applied correctly to the S031 fee if the patient falls within the specified age brackets, as these are percentage-based increases on the base surgical fee.
- If the procedure is performed after hours or on weekends in a non-hospital setting, ensure the appropriate after-hours procedure premium (e.g., E409 or E410) is appended to the claim to maximize reimbursement.
Provider Fee$197.55
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
To include nasopharynx, oropharynx, hypopharynx except where otherwise specified.
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