S225 – Rectum - excision of mucous membrane
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is a surgical procedure for the repair of a rectal prolapse, specifically involving the excision of the mucous membrane. This service is listed in the Digestive System section of the Schedule of Benefits and is performed for the treatment of rectal prolapse.
When to Use
- Use S225 specifically for the excision of rectal mucous membrane when performing a surgical repair of rectal prolapse.
- Choose S225 when the procedure is limited to the excision of the mucous membrane, as opposed to more extensive procedures like S226 (rectopexy) or S228 (proctectomy).
Common Pitfalls
- Billing S225 in conjunction with a hospital admission assessment; this is disallowed unless the assessment qualifies as the 'major pre-operative visit' where the decision to operate was finalized.
- Failing to document the specific surgical technique used, which can lead to audit scrutiny if the procedure is later challenged as being a more complex or different surgical code.
Billing Tips
- Ensure the surgical assistant (S225B) and anaesthesiologist (S225C) fees are calculated using the correct base units (6 and 7, respectively) plus time units as specified in the Schedule of Benefits.
- Apply the appropriate age-based fee premium (e.g., for patients under 16 years) to both the primary surgical code S225A and the assistant code S225B to maximize eligible reimbursement.
Effective: April 1, 2026
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
All insured services must be documented in the patient's medical record, establishing that the service was provided, medically necessary, and is the same service for which the account is submitted.
The written request for consultation leading to the surgery must be kept in the consulting physician's record, except in shared medical record environments where it may be on the common record.
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