What is OHIP billing code S172?

S172 is "Total colectomy with mucosal proctectomy with ileal pouch, ileoanal anastomosis and loop ileostomy", an OHIP Urology code from the Ontario Schedule of Benefits (Physician Services).

How much does S172 pay?

The current OHIP fee for S172 is $2247.70, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill S172 to OHIP?

S172 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates S172 claims against the Schedule of Benefits rules before submission.

What codes are related to S172?

Codes related to S172 in the Schedule of Benefits include E793, S169, S171, E808.

All codes

S172

S172 – Total colectomy with mucosal proctectomy with ileal pouch, ileoanal anastomosis and loop ileostomy

OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

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This is a complex surgical procedure involving: - Total colectomy: Removal of the entire large intestine (colon). - Mucosal proctectomy: Removal of the inner lining (mucosa) of the rectum while preserving the outer muscular wall and sphincter muscles. - Ileal pouch creation: Construction of a reservoir (pouch) from the end of the small intestine (ileum). - Ileoanal anastomosis: The newly created ileal pouch is connected to the anal canal. - Loop ileostomy: A temporary external opening (stoma) is created to divert fecal matter, allowing the ileoanal anastomosis to heal.

When to Use

Use S172 when performing a restorative proctocolectomy (IPAA) for ulcerative colitis or familial adenomatous polyposis where the entire colon and rectal mucosa are removed.
Select S172 specifically when the procedure includes the creation of an ileal pouch and a diverting loop ileostomy, distinguishing it from a simple total colectomy (S169).

Common Pitfalls

Failing to append the E793 modifier when the procedure is performed laparoscopically, which results in a missed 25% fee increase.
Billing S172 alongside other abdominal procedures that are considered inclusive to the surgical approach, leading to claim rejections for unbundling.

Billing Tips

Ensure the operative report explicitly details the mucosal proctectomy and the construction of the ileal pouch to support the complexity of S172 over less comprehensive colectomy codes.
Always verify the patient's age and trauma status to apply the appropriate percentage premiums (AGE_PREMIUM_UNDER_16 or TRAUMA_PREMIUM) as these are not automatically calculated by the system.

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Provider Fee$2,247.70

Surgical Assistant Fee$112.59

Anaesthetist Fee$154.90

Non-Anaesthetist Fee$154.90

Effective: April 1, 2025

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