S085 – Oesophagostomy, Cervical - neonatal
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving an incision to create an artificial opening into the esophagus in the cervical (neck) region, specifically for a neonatal patient. The term 'neonatal' applies to a patient from birth up to and including 28 days of age, as defined on page . The surgical fee is a flat rate. The anaesthesia fee is calculated based on time units plus basic units determined by Independent Consideration (IC). Assistant fees are not payable for this procedure. Refer to for the listing.
When to Use
- Use S085 for the creation of a cervical oesophagostomy in a neonate (0-28 days) specifically for nutritional access or decompression.
- Select S085 over S084 when the patient meets the strict neonatal age criteria, as S084 is intended for older pediatric or adult patients.
Common Pitfalls
- Attempting to bill for a surgical assistant (suffix B) will result in an automatic rejection, as this procedure is explicitly non-eligible for assistant fees.
- Failing to apply the 30% AGE_PREMIUM_NEONATE is a common revenue loss, as this premium is mandatory for all surgical procedures performed on patients under 30 days of age.
- Forgetting to document the Independent Consideration (IC) justification for the anaesthesia fee (suffix C) will lead to processing delays or manual review.
Billing Tips
- Ensure the anaesthesiologist includes the E014C (5 extra units) and, if applicable, E021C (9 extra units for prematurity) to maximize the anaesthesia claim.
- Always verify the exact time of the procedure commencement to determine if after-hours premiums (E409, E410, E400C, or E401C) apply to the surgeon or anaesthesiologist fees.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
neonatal
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