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S103
S103 – Closure of H-type tracheo-oesophageal fistula
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service is for the surgical closure of an H-type tracheo-oesophageal fistula, performed using either a cervical or thoracic approach. As a major surgical procedure, the fee includes the major pre-operative visit, the operation itself, and normal post-operative care as defined in the Surgical Preamble. This procedure is eligible for surgeon (A), assistant (B), and anaesthetist (C) suffixes, with assistant and anaesthetist fees calculated based on unit values.
When to Use
- Use S103 specifically for the surgical repair of a congenital H-type tracheo-oesophageal fistula where the fistula tract is identified between the trachea and the oesophagus.
- Select S103 when the procedure is performed via either a cervical or thoracic approach, as the code encompasses both surgical routes.
Common Pitfalls
- Do not bill S103 in conjunction with other major surgical procedures performed during the same operative session unless they are distinct, unrelated procedures that qualify for the multiple procedure rule.
- Avoid billing separate pre-operative assessment fees, as the S103 fee is inclusive of the major pre-operative visit and routine post-operative care within the 14-day period.
- Failure to document the specific age of the patient can lead to missed revenue, as the age-based premiums (e.g., under 30 days, under 1 year) significantly increase the total payable amount.
Billing Tips
- Ensure the claim includes the correct suffix (A for surgeon, B for assistant, C for anaesthetist) to trigger the appropriate unit-based calculation for assistants and anaesthetists.
- If the procedure qualifies as non-elective and is performed during after-hours or night periods, ensure the corresponding E-series premium (E409 or E410) is submitted on the same claim to receive the percentage increase.
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