S195 – Local excision of lesion
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
S195 is a surgical procedure for the local excision of a lesion from the mesentery. Payment for this service includes the common elements applicable to all insured services and the specific elements of surgical procedures as defined in the General Preamble. This service is eligible for surgical assistant (suffix B) and anaesthetist (suffix C) services, which are calculated based on basic and time units. Various premiums for after-hours services, special visits, patient age, and other complicating factors may be applicable to the surgeon, assistant, and anaesthetist fees. See the relevant sections of the Schedule of Benefits for detailed rules.
When to Use
- Use S195 for the isolated excision of a benign or localized mesenteric lesion where no bowel resection is required.
- Use S195 when performing a simple excision of a mesenteric cyst or localized mesenteric mass that does not involve the resection of the adjacent intestine.
Common Pitfalls
- Billing S195 in conjunction with a bowel resection code (e.g., S159) is a common error; the excision of the lesion is typically considered part of the resection procedure and is not separately billable.
- Failure to document the specific mesenteric location can lead to audit scrutiny, as S195 is strictly for the mesentery and not for general abdominal or retroperitoneal masses.
Billing Tips
- Ensure that if an assistant or anaesthetist is utilized, their claims are linked to the same procedure start time to ensure after-hours premiums (E400B/C or E401B/C) are processed correctly.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
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