S322 – Inguinal and/or femoral hernia repair - infants
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the repair of an inguinal and/or femoral hernia in an infant. This procedure is listed under the Digestive System Surgical Procedures section of the Schedule of Benefits. Age restrictions apply as per the definition of an infant in the General Preamble (). Add-on code E726 is payable for repeat recurrent inguinal hernias. This service is also eligible for various age-based, after-hours, and trauma premiums under specific conditions.
When to Use
- Use S322 for the primary repair of an inguinal or femoral hernia in patients aged 29 days up to, but not including, 2 years.
- Use S322 in conjunction with add-on code E726 specifically when performing a repair on a recurrent inguinal hernia that has already undergone more than two previous repairs.
Common Pitfalls
- Billing S322 for patients under 29 days old or 2 years and older will result in automatic rejection due to strict age-based eligibility.
- Attempting to claim E726 for a first or second recurrence is incorrect; it is strictly reserved for patients who have already had more than two prior repairs.
- Failing to apply the mandatory age-based premiums (25% for <1 year, 20% for 1-2 years) results in significant under-billing of the procedure fee.
Billing Tips
- Always verify the patient's exact age in days at the time of service to ensure the correct age-based premium (AGE_PREMIUM_LT_1_YR or AGE_PREMIUM_1_TO_2_YRS) is applied to the surgeon, assistant, and anaesthetist fees.
- When performing non-elective repairs after hours, ensure the appropriate E-series procedural premium is claimed alongside the base fee to maximize the surgical reimbursement.
Effective: April 1, 2026
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Service is for infants, defined as a person from 29 days up to, and less than, 2 years of age.
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