S092 – Oesophageal hiatus hernia - recurrent
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical repair of a recurrent oesophageal hiatus hernia. This procedure is performed when a previously repaired oesophageal hiatus hernia has recurred. Payment Rules and Add-ons: - Laparoscopic/Thoracoscopic Assistance: Add 25% to the fee when performed laparoscopically, thoracoscopically, or with combined assistance using code E793A. - Gastroplasty: If a gastroplasty is also performed, add E744A. - Diaphragm Reconstruction: If diaphragm reconstruction with mesh or equivalent synthetic material is required, add E847A. - Concurrent Procedures: If performed with cholecystectomy, and/or vagotomy with or without drainage procedures, add E742A for each additional procedure. For any other combination of surgical procedures with oesophageal hiatus hernia repair (with the exception of S161 and S100), see Surgical Preamble . - Second Assistant: Payment for a second surgical assistant (S092B) is allowed without special authorization.
When to Use
- Use S092 specifically for the surgical repair of a hiatus hernia that has previously undergone a primary repair, distinguishing it from the primary repair code S091.
- Apply this code when performing a revision of a failed Nissen or other anti-reflux procedure where the hernia has recurred post-operatively.
Common Pitfalls
- Billing S092 as a primary repair (S091) is a common error; ensure the operative report clearly documents the presence of previous surgical hardware or scar tissue indicative of a recurrent hernia.
- Failing to append the E793A add-on for laparoscopic or thoracoscopic approaches will result in a 25% underpayment of the base fee.
- Attempting to bill concurrent procedures not explicitly listed in the S092 payment rules without referencing the Surgical Preamble SP2, which may lead to automatic claim rejection.
Billing Tips
- Always verify if mesh was used for the diaphragm reconstruction; if so, you must include E847A to capture the additional $75.00 flat fee.
- If performing a cholecystectomy or vagotomy concurrently, ensure E742A is added for each distinct procedure to maximize the claim value.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Payment rules for S092 are listed with S091 and S079.
A second assistant's service for S092 is eligible for payment without requiring authorization by a medical consultant.
Payment for assistant (S092B) and anaesthetist (S092C) services is calculated based on basic units plus time-based units as outlined in the General Preamble (see - for assistant and - for anaesthetist).
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