S087 – Intrathoracic diverticulum
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This surgical procedure involves the excision of an intrathoracic diverticulum of the oesophagus. A premium is available if this procedure is performed using specific minimally invasive techniques. The fee for an assistant and anaesthetist for this service is determined by independent consideration.
When to Use
- Use S087 for the definitive surgical excision of a symptomatic intrathoracic esophageal diverticulum, such as a Zenker's diverticulum that has extended into the mediastinum or a mid-thoracic traction diverticulum.
- Use S087 when performing a formal resection of the diverticular sac; do not use this code for simple endoscopic dilation or non-surgical management of esophageal pathology.
Common Pitfalls
- Failure to append the E683 premium when performing the procedure via VATS or robotic-assisted approach, which results in a significant underpayment of the 35% surgical fee increase.
- Attempting to bill S087 alongside other esophageal procedures without clear documentation of distinct, separate surgical sites, which risks rejection as an 'included' or 'incidental' service.
- Omitting the Injury Severity Score (ISS) from the medical record when attempting to claim the E420 trauma premium, which is a mandatory requirement for audit compliance.
Billing Tips
- Always verify the exact start time of the procedure to ensure correct application of after-hours premiums (E409/E410), as these are strictly dependent on the commencement time of the surgery.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
All insured services must be documented in appropriate records that establish: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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