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S304
S304 – Lateral pancreatoduodenostomy or anastomosis of filleted pancreatic duct to intestine (Puestow)
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Lateral pancreatoduodenostomy or anastomosis of filleted pancreatic duct to intestine (Puestow).
When to Use
- Use S304 for the surgical management of chronic pancreatitis when a longitudinal pancreaticojejunostomy (Puestow procedure) is performed to decompress a dilated pancreatic duct.
- Select this code when the pancreatic duct is filleted and anastomosed to a Roux-en-Y limb of the jejunum to alleviate pain associated with ductal obstruction.
Common Pitfalls
- Do not bill S304 in conjunction with other pancreatic resection codes unless a distinct, separate procedure is performed, as this may trigger an audit for unbundling.
- Failure to document the specific diameter of the pancreatic duct or the clinical indication for decompression (e.g., chronic pain refractory to medical management) increases the risk of claim rejection during post-payment review.
- S304 is not on the pre-approved list for a second surgical assistant; billing for one without prior authorization and a supporting letter from the surgeon will result in automatic denial.
Billing Tips
- Ensure that the operative report explicitly details the 'filleting' of the duct and the creation of the anastomosis to the intestine to support the specific requirements of the S304 descriptor.
- If the procedure is performed on an emergency basis, ensure the appropriate after-hours or trauma premiums are appended to the claim to maximize the procedural fee.
Provider Fee$926.45
Surgical Assistant Fee$116.19
Anaesthetist Fee$159.60
Non-Anaesthetist Fee$159.60
Effective: April 1, 2026
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
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