S125 – Partial or subtotal gastrectomy - proximal
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Partial or subtotal gastrectomy, proximal. This is a major surgical procedure listed in the Digestive System section of the Schedule. The service is billable by the primary surgeon (suffix 'A'), and separate claims can be submitted for a surgical assistant (suffix 'B') and an anaesthesiologist (suffix 'C'). The fees for assistant and anaesthesia services are calculated using a combination of basic units and time-based units. Specific add-on codes may apply, including those for suture of bleeding peptic ulcer (E731), vagotomy (E708), cholecystectomy (E709), previous gastro-enterostomy (E711), choledochotomy (E706), previous vagotomy and pyloroplasty (E712), previous partial gastrectomy (E713), radical mediastinal node dissection (E644), reconstruction of diaphragm (E847), and laparoscopic or laparoscopic assisted approach (E793). See - for detailed rules on surgical, assistant, and anaesthesia billing.
When to Use
- Use S125 for proximal partial or subtotal gastrectomy procedures where the primary intent is the resection of the upper stomach.
- Apply S125 when performing a proximal gastrectomy for gastric malignancy or severe refractory peptic ulcer disease requiring resection of the cardia/fundus.
Common Pitfalls
- Failing to append the E793 add-on code when the procedure is performed laparoscopically, which results in a missed 25% fee increase.
- Neglecting to bill specific add-on codes like E708 (vagotomy) or E709 (cholecystectomy) when these are performed concurrently, as they are not included in the base S125 fee.
- Incorrectly billing for a second assistant using a manual override when the system automatically recognizes S125 as eligible for a second assistant without prior authorization.
Billing Tips
- Always verify the surgical approach to ensure E793 is applied to the base fee of S125 for all laparoscopic or laparoscopic-assisted cases.
- Ensure that when multiple procedures are performed, the assistant and anaesthesia units are calculated based on the major procedure (S125) as per GP85 and GP93.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
A second assistant's service is payable for S125 and authorization is not required.
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