S114 – Sleeve gastrectomy
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Sleeve gastrectomy is a surgical procedure performed for morbid obesity (defined as Body Mass Index [BMI] > 40). It is only eligible for payment under specific circumstances: 1. When a Roux-en-Y gastric bypass is not possible due to small bowel disease, adhesions, or previous surgery. 2. When it is performed as a planned staged surgery for patients with a BMI greater than 60, with the intention of enabling weight loss before a subsequent gastric bypass with Roux-en-Y. An additional 25% is payable on the surgical fee if the procedure is performed laparoscopically or is laparoscopically assisted, claimed using E793.
When to Use
- Use S114 when a Roux-en-Y gastric bypass is contraindicated due to documented small bowel disease, extensive adhesions, or prohibitive previous abdominal surgery.
- Use S114 as a bridge procedure for patients with a BMI > 60, specifically documented as a planned staged surgery to facilitate weight loss prior to a subsequent Roux-en-Y gastric bypass.
Common Pitfalls
- Claiming S114 for routine bariatric cases where a standard Roux-en-Y gastric bypass is clinically feasible will lead to rejection or audit recovery.
- Failing to explicitly document the clinical justification (e.g., specific adhesions or BMI > 60 staging plan) in the operative report creates a high risk of audit clawback.
- Forgetting to append E793 when the procedure is performed laparoscopically, as the 25% premium is not automatically applied.
Billing Tips
- Always link the laparoscopic premium E793 to the S114 claim to ensure the 25% fee increase is processed correctly.
- Ensure the patient's BMI is clearly recorded in the claim notes or hospital chart, as S114 is strictly restricted to patients with a BMI > 40.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
1. S114 Sleeve gastrectomy is only eligible for payment when: a. a Roux-en-Y gastric bypass is not possible due to small bowel disease/adhesions or previous surgery; or b. performed as a planned staged surgery in patients with a BMI > 60 to enable the patient to lose weight.
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