S122 – Wedge resection for ulcer
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
The full description for S122 is now available from page . As an 'S' code surgical procedure, payment is governed by the general rules for surgery, surgical assistance, and anaesthesia outlined in the General Preamble. This includes calculation of fees based on basic and time units for the surgeon, assistant (7 basic units), and anaesthesiologist (7 basic units). Various premiums may apply, such as those for patient age, after-hours service, and specific anaesthetic conditions. A second assistant requires special authorization as S122 is not on the pre-approved list.
When to Use
- Use S122 for the surgical excision of a gastric or duodenal ulcer where a formal wedge resection is performed as the primary therapeutic intervention.
- Apply S122 when performing a wedge resection for a perforated ulcer that does not require a more extensive gastrectomy or pyloroplasty.
Common Pitfalls
- Billing S122 alongside a more comprehensive gastric resection code is a common audit trigger; ensure the procedure performed is strictly a wedge resection.
- Failing to append the E793 modifier when the procedure is performed laparoscopically results in a 25% underpayment of the surgical fee.
- Attempting to bill for a second surgical assistant without prior Ministry authorization will result in an automatic rejection of the assistant's claim.
Billing Tips
- Always verify if the procedure was laparoscopic to ensure the 25% fee increase via E793 is applied to the base S122 fee.
- If the surgery is aborted after anaesthesia induction but before the incision, ensure you bill E006C instead of S122 to avoid claim rejection.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
The medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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