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S065
S065 – Adenoidectomy
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Adenoidectomy is the surgical removal of the adenoids. This procedure may be performed with the addition of a flexible endoscope, which is claimed using the add-on code E839.
When to Use
- Use S065 for the primary surgical removal of adenoids in pediatric or adult patients.
- Use S065 in conjunction with E839 when a flexible endoscope is explicitly utilized to visualize or assist in the adenoidectomy procedure.
Common Pitfalls
- Billing E839 without clear documentation of the use of a flexible endoscope, which is a frequent trigger for manual review or audit.
- Failing to apply the correct age-based fee premium (e.g., 10% to 30% increase) which is mandatory for S065 based on the patient's age at the time of service.
- Attempting to bill S065 alongside other nasal or throat procedures without verifying if the codes are considered inclusive or mutually exclusive under the Schedule of Benefits.
Billing Tips
- Always confirm the patient's exact age in days or years to ensure the correct percentage premium is applied to the base fee of $101.25.
- If a surgical assistant is required for S065, use the 6 basic units listed in the Anaesthesia column to calculate the assistant's fee, or submit via M400B if no basic unit is explicitly assigned.
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