S256 – Excision of scar, for stenosis
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
An S-prefix surgical procedure for the repair of rectal stenosis through the excision of scar tissue. The '#' prefix on this code, as described on page , indicates that for services performed in a hospital, the premises, equipment, supplies, and personnel are funded through the hospital's budget. Patients cannot be charged for these items for services with a '#' prefix rendered outside a hospital or ICHSC. This procedure is eligible for surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C) services. The assistant and anaesthetist fees are calculated based on 6 basic units plus applicable time units.
When to Use
- Use S256 specifically for the surgical excision of scar tissue causing symptomatic rectal stenosis.
- Use this code when the procedure is performed as a distinct surgical intervention, rather than as an incidental component of a larger procedure like a formal proctoplasty or resection.
Common Pitfalls
- Billing S256 alongside other major rectal procedures performed under the same anaesthetic may trigger payment adjustments; ensure the assistant and anaesthetist units are claimed only for the major procedure.
- Failing to document the specific nature of the stenosis and the excision of scar tissue can lead to audit rejections, as the code is specific to scar excision and not general dilation or lysis of adhesions.
Billing Tips
- If the patient is under 16 years of age, ensure the appropriate age-based premium is applied to the S256 fee to maximize reimbursement.
- For non-elective procedures performed after hours, append the E409 or E410 premium code to the claim to receive the 50% or 75% increase, respectively.
Effective: April 1, 2026
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
As per , all insured services must be documented in the patient's medical record to establish that the service was provided, is the service for which the account is submitted, and was medically necessary.
Anaesthesia: 6 basic units.
Assistant: 6 basic units.
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