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S063
S063 – Tonsillectomy and may include adenoidectomy
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
When to Use
- Use S063 for a standard tonsillectomy, which inherently covers the inclusion of an adenoidectomy if performed during the same operative session.
- Use S063 when performing a tonsillectomy in conjunction with a flexible endoscope, ensuring you also claim add-on code E839 to capture the additional procedural fee.
Common Pitfalls
- Do not attempt to bill S063 and S065 (adenoidectomy) together; S063 is inclusive of adenoidectomy, and billing both will result in a rejection for duplicate service.
- Do not bill S063B for surgical assistance; assistance at surgery for this procedure must be claimed using M400B and requires prior authorization from a medical consultant.
Billing Tips
- Always append the appropriate age premium (e.g., AGE_PREMIUM_LT16Y) to S063, as these are automatically calculated based on the patient's date of birth and significantly increase the total procedural value.
- If the procedure is performed after hours, ensure you select the correct premium (E409 or E410) to increase the procedural fee by 50% or 75% respectively, provided it meets the non-elective criteria.
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