S120 – Gastric bypass with Roux-en-Y anastomosis, for morbid obesity
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Gastric bypass with Roux-en-Y anastomosis, for morbid obesity.
When to Use
- Use S120 for the primary Roux-en-Y gastric bypass procedure in patients with a BMI > 40.
- Use S120 as the definitive second-stage procedure when a patient has completed a prior staged surgery (such as a sleeve gastrectomy) and now meets the criteria for a full Roux-en-Y reconstruction.
Common Pitfalls
- Billing S120 for 'mini-gastric' or loop gastric bypass procedures, which are explicitly excluded from this code definition.
- Attempting to bill S120 in conjunction with S189 or S160, which will result in automatic claim rejection.
- Failure to document the patient's BMI > 40 in the clinical record, which is a mandatory requirement for the service to be considered insured.
Billing Tips
- Always append the E793 add-on code to receive the 25% premium when the procedure is performed using a laparoscopic or laparoscopic-assisted technique.
- Ensure the surgical assistant and anaesthesiologist units are calculated based on the specific base units (7 and 10, respectively) defined for S120.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
The fee for the surgeon (suffix A) is a flat fee of $1350.00.
Surgical Assistant (suffix B) fee calculation includes 7 base units.
Anaesthesiologist (suffix C) fee calculation includes 10 base units.
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.
S120 is an insured service only when all of the conditions set out in the Surgical Preamble are satisfied.
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