S128 – Total gastrectomy - with or without splenectomy
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
S128 is a surgical procedure for total gastrectomy, which may or may not include a splenectomy. It is listed under the 'Digestive System Surgical Procedures' section of the OHIP Schedule of Benefits.
When to Use
- Use S128 for the complete surgical removal of the stomach, regardless of whether a splenectomy is performed concurrently.
- Select S128 for total gastrectomy procedures performed for gastric malignancy or severe benign conditions requiring complete resection.
Common Pitfalls
- Do not bill a separate fee for splenectomy, as it is considered inclusive in the S128 fee and will result in a rejection for duplicate service.
- Failing to append the E793 percentage-based add-on when the procedure is performed laparoscopically results in a significant under-billing of the surgical fee.
- Attempting to bill a second assistant fee without prior medical consultant authorization will lead to automatic rejection, as S128 is not on the pre-approved list for second assistants.
Billing Tips
- Always verify if the patient has a history of partial gastrectomy to ensure the E713 add-on is applied, as this is a common oversight in complex oncology cases.
- Ensure that if a radical mediastinal node dissection is performed following neoadjuvant therapy, the E644 flat-fee add-on is claimed in addition to the base S128 code.
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 claimed is the service rendered, and the service was medically necessary, as per the Act.
The Injury Severity Score (ISS) must be listed in the medical record for the E420 trauma premium to be payable.
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