All codes
S258A
S258A – Repair of Anal Sphincter - Surgeon
OHIP Urology Code — Rectum · Schedule of Benefits
When to Use
- Use S258A for the primary surgical repair of an anal sphincter defect, such as a third or fourth-degree obstetric laceration.
- Use this code for the surgical reconstruction of the anal sphincter following traumatic injury, provided the criteria for E420 are not met or the trauma premium is not being claimed.
Common Pitfalls
- Billing S258A in conjunction with other rectal procedures without checking for Schedule of Benefits rules regarding multiple procedure logic, which may lead to automatic fee reductions.
- Failing to bill S258B or S258C separately when an assistant or anaesthesiologist is present, as S258A only covers the surgeon's fee.
- Attempting to claim E420 (Trauma Premium) without documenting the required Injury Severity Score (ISS) in the patient record, which will result in a clawback during audit.
Billing Tips
- Always verify if the procedure qualifies for age-based premiums (e.g., AGE_PREMIUM_LT30D) if the patient is under 16, as these are percentage-based additions to the base fee.
- Ensure that if the procedure is performed after hours, you select the correct premium (E409 or E410) based on the exact start time to maximize the percentage increase.
Provider Fee$275.05
Surgical Assistant Fee$75.06
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Category
Digestive System Surgical Procedures
Subcategory
Rectum
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
The '#' prefix indicates that for services performed in a hospital or Integrated Community Health Services Centre (ICHSC), the provision of premises, equipment, supplies, and personnel are funded by the facility and not included in the physician fee. See .
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