S194 – Meckel’s diverticulum excision
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service provides for the surgical removal of a Meckel's diverticulum. It is a major surgical procedure listed in the Digestive System section of the OHIP Schedule of Benefits. The fee for the surgeon is a flat rate, while fees for the surgical assistant and anaesthetist are calculated based on basic and time units as specified in the Schedule (Assistant: 6 base units, Anaesthesia: 7 base units). Additional premiums may apply based on patient age, time of day, and patient's clinical condition (e.g., trauma).
When to Use
- Use S194 for the definitive surgical excision of a symptomatic Meckel's diverticulum.
- Use S194 when performing a diverticulectomy as an isolated procedure, as opposed to S159 which typically covers more extensive small bowel resections.
Common Pitfalls
- Attempting to bill a second assistant for S194 will result in rejection, as it is not on the pre-approved list and requires formal Independent Consideration (IC) authorization.
- Claiming the Trauma premium (E420) without explicitly documenting the Injury Severity Score (ISS) in the patient's medical record will lead to automatic audit recovery.
Billing Tips
- Ensure the procedure start time is accurately recorded, as this is the sole determinant for applying after-hours premiums (E409, E410) and surgical assistant/anaesthesia after-hours multipliers.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
When claiming the Trauma premium (E420), the medical record must list the Injury Severity Score (ISS).
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