S199 – Resection of mesentery
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Resection of mesentery. This is a surgical procedure payable to the operating surgeon (suffix A). Assistant (suffix B) and Anaesthesiologist (suffix C) services are also payable based on basic units plus time units as defined in the - of the Schedule of Benefits. - Assistant Fee: 6 basic units plus time units. - Anaesthesia Fee: 6 basic units plus time units.
When to Use
- Use S199 when performing a standalone resection of the mesentery, such as for a mesenteric cyst or localized mesenteric pathology, where no bowel resection is performed.
- Use S199 as the primary procedure code when the mesenteric resection is the definitive surgical intent, distinguishing it from S195 which pertains to different bowel-related surgical interventions.
Common Pitfalls
- Billing S199 in addition to a bowel resection code is often flagged as unbundling; if the mesenteric resection is incidental to a bowel resection, it is generally considered part of the primary procedure.
- Failure to document the specific pathology or extent of the mesenteric resection can lead to audit rejections, as the Ministry may view the service as integral to a more comprehensive abdominal surgery.
Billing Tips
- Ensure the operative report clearly delineates the mesenteric resection as a distinct surgical step if you are attempting to bill it alongside other digestive system procedures to avoid automatic rejection for inclusive services.
- Always verify if the procedure qualifies for age-based premiums (e.g., AGE_PREMIUM_LT16Y) or after-hours premiums (E409/E410) based on the patient's age and the exact start time of the surgery to maximize the claim value.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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