S058 – Branchial cleft lesion
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of a branchial cleft lesion. As a surgical service, this includes the procedure itself as well as associated pre-operative and post-operative care as defined in the Schedule. See S059 for a repeat procedure involving a branchial cleft lesion. This service has 6 basic units for a surgical assistant and 7 basic units for anaesthesia. Payment for the surgical assistant (suffix B) and anaesthetist (suffix C) are calculated based on these basic units plus time units, as described in the General Preamble (, ).
When to Use
- Use S058 for the primary excision of a branchial cleft cyst or sinus tract.
- Use S058 when performing the initial definitive surgical removal of a branchial cleft lesion, distinguishing it from the repeat procedure code S059.
Common Pitfalls
- Billing S058 for a repeat or revision procedure, which must be billed under S059 to avoid rejection or audit recovery.
- Failing to document the specific anatomical location or nature of the lesion, which is essential for justifying the surgical fee during an audit.
- Incorrectly applying after-hours premiums (E409/E410) to elective cases; these are strictly for non-elective or emergency-delayed procedures.
Billing Tips
- Ensure that if multiple surgical procedures are performed under the same anaesthetic, you only claim the basic units for the major procedure as per the General Preamble.
- Always verify the patient's age at the time of the procedure to automatically apply the correct age-based fee premium (e.g., AGE_PREMIUM_LT_16Y), as these are not automatically calculated by the system.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
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