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S086
S086 – Cricopharyngeal myotomy, open approach
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs a cricopharyngeal myotomy using an open surgical approach. This service is listed under the Digestive System surgical procedures for the oesophagus. According to the Schedule of Benefits, S086 is not eligible for payment if billed with S088 (cricopharyngeal diverticulum) or Z505 (endoscopic cricopharyngeal myotomy).
When to Use
- Use S086 for an open cervical approach to perform a cricopharyngeal myotomy for oropharyngeal dysphagia.
- Use this code when the procedure is performed as a standalone open surgical intervention, distinct from diverticulum repair or endoscopic approaches.
Common Pitfalls
- Billing S086 in conjunction with S088 (cricopharyngeal diverticulum) will trigger an automatic rejection as these are considered mutually exclusive.
- Attempting to bill S086 alongside Z505 (endoscopic cricopharyngeal myotomy) is prohibited; ensure the surgical approach matches the code submitted.
- Assuming assistant (suffix B) coverage is automatic; it is not, and requires a formal letter of justification to a medical consultant for potential authorization.
Billing Tips
- For anaesthetist (suffix C) billing, calculate the fee by adding time units to the basic units of a comparable procedure, as no fixed basic units are assigned to S086.
- If the procedure is performed on a pediatric patient, verify the age-based percentage increase (e.g., 30% for <30 days) to maximize the claim value.
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