S249 – Local excision for malignancy
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
S249 is a surgical procedure for the local excision of a malignancy in the rectum. This procedure is listed under the Digestive System section of the Schedule of Benefits. The prefix '#' indicates that for services performed in a hospital, the premises, equipment, supplies, and personnel are funded by the hospital global budget (:).
When to Use
- Use S249 for the excision of a localized rectal malignancy when the procedure is limited to the rectal wall and does not involve a formal radical resection.
- Use S249 when performing a transanal excision of a rectal polyp that is confirmed to be malignant on pathology, distinguishing it from benign polyp removal codes like S248.
Common Pitfalls
- Billing S249 alongside a more extensive procedure like an anterior resection or abdominoperineal resection is considered unbundling and will result in claim rejection.
- Failing to document the specific malignant diagnosis in the operative report can lead to audit recovery, as S249 is strictly for malignancy.
Billing Tips
- Ensure the pathology report is finalized and supports the diagnosis of malignancy to justify the use of S249 over other non-malignant rectal excision codes.
- If the procedure is performed after hours, ensure the start time is clearly documented to support the application of E409 or E410 premiums.
Effective: April 1, 2026
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
The prefix '#' indicates that for services performed in a hospital, the premises, equipment, supplies, and personnel are funded by the hospital global budget. For services in an Integrated Community Health Services Centre (ICHSC), they are funded under the facility costs. Patients cannot be charged for these items if the service is rendered outside of a hospital or ICHSC.
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