S346 – Congenital diaphragmatic hernia - Primary or first stage repair
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Primary or first stage repair of a congenital diaphragmatic hernia.
When to Use
- Use S346 for the initial surgical correction of a congenital diaphragmatic hernia in a neonate or infant.
- Use this code for the first stage of a staged repair when the defect is too large for primary closure and requires a patch or prosthetic material.
Common Pitfalls
- Billing S346 alongside a second surgical assistant without prior authorization from a medical consultant will result in an automatic rejection.
- Confusing S346 with S347, S348, or S349; ensure the procedure matches the specific anatomical or complexity criteria defined for those related codes.
- Failing to document the specific start and end times for anaesthesia and surgical assisting, which are mandatory for calculating the correct time units beyond the base units.
Billing Tips
- Always apply the appropriate age-based premium (e.g., AGE_PREMIUM_UNDER_30D) to the base fee, as these patients almost exclusively fall into the neonatal or infant categories.
- Ensure the anaesthesiologist includes the relevant extra units (e.g., E014C or E009C) based on the patient's exact age in days to maximize the anaesthesia claim.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
The fee for the surgeon (S346A) is a flat rate. Assistant (S346B) and anaesthetist (S346C) fees are calculated based on units. Assistant: 9 base units. Anaesthetist: 13 base units. Time units are added to these base units as per the rules in the General Preamble (- for assistants, - for anaesthetists).
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