S260 – High imperforate anus repair (supra-levator)
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical repair of a high (supra-levator) imperforate anus. This service is designated with a '#' prefix, indicating that when performed in a hospital or Integrated Community Health Services Centre (ICHSC), the facility costs (premises, equipment, supplies, personnel) are funded by the hospital or ICHSC and cannot be charged to the patient.
When to Use
- Use S260 for the definitive surgical correction of a high (supra-levator) imperforate anus, typically involving a posterior sagittal anorectoplasty (PSARP) or similar approach where the rectal pouch is located above the levator muscle complex.
- Use this code for the primary repair procedure; do not use it for subsequent dilations or minor revisions, which should be billed under appropriate minor surgical or follow-up codes.
Common Pitfalls
- Billing S260 for low (trans-levator) imperforate anus repairs, which are distinct procedures and may require different codes; ensure the anatomical classification is clearly documented to support the 'high' designation.
- Attempting to bill facility fees or tray charges; as a '#' designated code, all facility costs are covered by the hospital, and any attempt to charge the patient will result in a billing violation.
Billing Tips
- Always apply the mandatory age-based fee premium (e.g., AGE_PREMIUM_LT_30D or AGE_PREMIUM_30D_TO_1Y) as these procedures are almost exclusively performed on neonates or infants, significantly increasing the total claim value.
- If the procedure is performed on an emergency basis after hours, ensure you append the correct after-hours premium (E409 or E410) to the base fee to capture the 50-75% increase, provided the timing criteria are strictly met.
Effective: April 1, 2026
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
The '#' prefix indicates that when this service is performed in a hospital or Integrated Community Health Services Centre (ICHSC), the facility costs are funded by the institution and not billable to the patient. See for details.
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