S079 – Massive paraesophageal hernia repair
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical repair of a massive paraesophageal hernia. This service is only eligible for payment for the surgical repair of either: a. a paraesophageal hernia with >50% intrathoracic herniation of the stomach with the fundus lying above the gastroesophageal junction, or b. a paraesophageal hernia with herniation of the stomach and any other abdominal organ(s) through the crus.
When to Use
- Use S079 for massive paraesophageal hernia repairs where imaging confirms >50% intrathoracic stomach herniation with the fundus positioned above the gastroesophageal junction.
- Use S079 when the surgical findings confirm the herniation of the stomach alongside other abdominal organs (e.g., spleen, colon) through the diaphragmatic crus.
Common Pitfalls
- Billing S079 for standard hiatal hernia repairs that do not meet the specific anatomical criteria for 'massive' classification, which should be billed under appropriate alternative codes.
- Attempting to bill S079 alongside S161 or S100, which are explicitly restricted and will result in claim rejection.
- Failure to document the specific anatomical findings (e.g., organ involvement or percentage of stomach herniation) required by the S9 preamble, leading to audit recovery.
Billing Tips
- Always append E793 for laparoscopic or thoracoscopic approaches to secure the 25% fee increase, and add E847 if mesh reconstruction is utilized.
- When performing concurrent procedures like cholecystectomy or vagotomy, use E742 to claim for each additional procedure performed in conjunction with S079.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Payment rules: S079 is only eligible for payment for surgical repair of a. a paraesophageal hernia with >50% intrathoracic herniation of the stomach with the fundus lying above the gastroesophageal junction, or b. a paraesophageal hernia with herniation of the stomach and any other abdominal organ(s) through the crus.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.