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S096
S096 – Ruptured oesophagus, suture and drainage
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is a surgical procedure for the repair of a ruptured oesophagus, involving suture and drainage. As a surgical service, this fee includes all related pre-operative and post-operative care provided by the surgeon (suffix A). The fee for the surgical assistant (suffix B) and anaesthetist (suffix C) includes all specific elements for those roles as defined in the Schedule of Benefits, including pre-anaesthetic evaluation, anaesthetic procedure, and post-anaesthetic follow-up. See - for surgical assistant rules and - for anaesthesiologist rules.
When to Use
- Use S096 for the primary surgical repair of a spontaneous or traumatic esophageal rupture requiring direct suture and drainage.
- Use S096 when the procedure is performed via open thoracotomy or laparotomy; if performed via VATS or robotic-assisted approach, ensure E683 is added to the claim to capture the 35% premium.
Common Pitfalls
- Failure to document the Injury Severity Score (ISS) in the medical record when billing the E420 trauma premium, which leads to automatic rejection of the 50% increase.
- Attempting to bill separate pre-operative or post-operative visits; the S096 fee is a global surgical fee that includes all routine pre- and post-operative care provided by the surgeon.
- Incorrectly billing after-hours premiums (E400B/C, E401B/C) without ensuring the procedure start time strictly aligns with the defined OHIP time windows.
Billing Tips
- Always verify if the procedure qualifies as non-elective to trigger eligibility for after-hours premiums (E409/E410) and associated special visit premiums (C998B/C, C999B/C).
- If a second surgical assistant is required due to the complexity of the rupture, bill the second assistant's service as per the Schedule of Benefits, as S096 allows for this without prior authorization.
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