S137 – Pyloroplasty or gastroenterostomy plus vagotomy and cholecystectomy
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This surgical service combines multiple procedures: a pyloroplasty or gastroenterostomy, a vagotomy, and a cholecystectomy. This service is eligible for surgeon (A), assistant (B), and anaesthetist (C) claims. The fee for the assistant is based on 7 base units plus time units. The fee for the anaesthetist is based on 8 base units plus time units. Additional fees can be claimed for specific concurrent procedures, such as E731 for suturing a bleeding peptic ulcer or E721 for a choledochotomy.
When to Use
- Use S137 when performing a definitive surgical treatment for peptic ulcer disease that necessitates both a vagotomy and a drainage procedure (pyloroplasty or gastroenterostomy) alongside a cholecystectomy.
- Select S137 for complex upper abdominal cases where the gallbladder is removed during the same operative session as the required vagotomy and gastric drainage procedure.
Common Pitfalls
- Billing S137 in conjunction with other gastric procedures that are already inclusive of the vagotomy or pyloroplasty components, which will trigger a rejection for duplicate service.
- Failing to document the specific necessity for the concurrent cholecystectomy, which may lead to audit scrutiny regarding the medical necessity of combining these procedures.
Billing Tips
- Ensure that if a choledochotomy is performed, you append E721 to the claim, and if a bleeding peptic ulcer is sutured, you append E731 to capture the additional flat fees.
- If the procedure is non-elective or delayed by an emergency, verify eligibility for E409 or E410 to apply the appropriate percentage premium to the base fee.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
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