S318 – Panniculectomy
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Panniculectomy, including any necessary diastasis repair. This procedure is the surgical removal of a panniculus (an apron of skin and fat from the lower abdomen). Notes: - Panniculectomy is only insured in those circumstances described in Appendix D of this Schedule. Prior authorization of payment from the MOH is required. - S318 is not eligible for payment when performed in conjunction with abdominal or pelvic procedures unless the payment requirements for panniculectomy are separately fulfilled. Commentary: - In circumstances where the proposed panniculectomy surgery may include excision of a panniculus that extends below the mid thigh, the requesting physician must provide sufficient information with the request for prior authorization of payment. - Abdominoplasty is not an insured service.
When to Use
- Use S318 only for medically necessary excision of a panniculus as defined in Appendix D, specifically when documented clinical complications like chronic intertrigo or ulceration exist.
- Use S318 when the procedure is performed as a standalone surgery, as it is generally ineligible when bundled with other abdominal or pelvic procedures unless strict, separate medical necessity criteria are met.
Common Pitfalls
- Billing S318 for cosmetic abdominoplasty, which is explicitly excluded from OHIP coverage and will result in claim rejection or audit recovery.
- Failing to secure and document prior authorization from the Ministry of Health before performing the procedure, which is a mandatory requirement for payment eligibility.
- Attempting to bill S318 alongside other abdominal surgeries without clear, separate clinical justification, triggering automatic rejection due to the restriction on concurrent procedures.
Billing Tips
- If the pannus extends below the mid-thigh, ensure you include specific clinical evidence in your prior authorization request to be eligible for the E809 add-on fee.
- When performing an umbilical hernia repair concurrently with a medically necessary panniculectomy, use the E748 add-on code to capture the additional work, provided the base S318 authorization is in place.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
In circumstances where the proposed panniculectomy surgery may include excision of a pannus that extends below the mid thigh, the requesting physician must provide sufficient information with the request for prior authorization of payment.
Panniculectomy is only insured in those circumstances described in Appendix D of this Schedule. Prior authorization of payment from the MOH is required.
S318 is not eligible for payment when performed in conjunction with abdominal or pelvic procedures unless the payment requirements for panniculectomy are separately fulfilled.
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