S123 – Partial or subtotal gastrectomy - distal
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
S123 is a surgical procedure listed in the Schedule of Benefits. General payment rules for surgical procedures, including pre-operative and post-operative care, apply as outlined in the Surgical Preamble and the General Preamble. This service is eligible for surgeon (A), assistant (B), and anaesthetist (C) suffixes. Anaesthetist and assistant fees are calculated based on a combination of base units (specific to the procedure) and time units. Refer to the 'Surgical Assistants' Services' section starting on page and 'Anaesthesiologists' Services' section starting on page for detailed calculation rules.
When to Use
- Use S123 for a distal partial or subtotal gastrectomy performed via open approach for conditions such as gastric malignancy or refractory peptic ulcer disease.
- Use S123 in conjunction with add-on code E793 when the procedure is performed laparoscopically or via laparoscopic-assisted technique.
Common Pitfalls
- Billing S123 alongside E003B for a second assistant is strictly prohibited and will result in a claim rejection.
- Failing to include the E793 add-on code when the procedure is performed laparoscopically results in a significant underpayment of the 25% premium.
- Submitting S123 for a total gastrectomy is incorrect; use S125 instead for total procedures to avoid audit discrepancies.
Billing Tips
- Ensure the E793 add-on is linked to the S123 claim to capture the 25% fee increase for laparoscopic approaches.
- Verify that the anaesthetist and assistant time units are calculated based on the specific base units assigned to S123 in the Schedule of Benefits to prevent payment adjustments.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
All insured services must be documented in appropriate records. The 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.
When a service is rendered by a Medical Trainee, the medical record must identify the Supervising Physician, the Medical Trainee and level of training, a description of the service, patient consent, and evidence of supervision (e.g., sign-off or note of discussion).
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