S285 – Intrahepatic choledochoenterostomy
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Intrahepatic choledochoenterostomy is a complex surgical procedure involving the creation of a connection (anastomosis) between an intrahepatic bile duct (located above the common hepatic duct bifurcation) and a segment of the small intestine (enterostomy). This operation serves to bypass biliary obstructions that are situated high in the biliary tree, restoring the flow of bile into the digestive tract. The service is billable by the surgeon (S285A), an assistant (S285B), and an anaesthetist (S285C). The fee for the surgeon (suffix A) is a flat rate. The fees for the assistant (suffix B) and anaesthetist (suffix C) are calculated based on a system of basic and time units. For an assistant, the service includes 9 basic units plus time units. For an anaesthetist, the service includes 12 basic units plus time units. Refer to the Surgical Assistants' Services (:-) and Anaesthesiologists' Services (:-) sections of the General Preamble for detailed time unit calculations.
When to Use
- Use S285A for biliary bypass procedures specifically involving an anastomosis between an intrahepatic bile duct and the small intestine.
- Select this code when the obstruction is located high in the biliary tree, specifically above the common hepatic duct bifurcation, distinguishing it from lower-level biliary bypass procedures.
Common Pitfalls
- Billing S285A for a standard choledochojejunostomy or biliary bypass that does not involve an intrahepatic duct anastomosis will lead to rejection or audit recovery.
- Failure to document the specific anatomical level of the anastomosis (intrahepatic vs. extrahepatic) often results in claims being flagged for review.
- Incorrectly applying after-hours premiums (E400 series) without confirming the procedure was non-elective or delayed by an intervening surgical emergency.
Billing Tips
- Ensure the operative report clearly details the intrahepatic nature of the ductal connection to support the use of S285 over other biliary bypass codes.
- For surgical assistants and anaesthetists, verify that the time units are calculated strictly according to the General Preamble sections GP85 and GP92 respectively to avoid payment discrepancies.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
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