S413 – Nephrectomy - Lumbar
OHIP Urology Code — Kidney and Upper Urinary Tract · Schedule of Benefits
A surgical procedure for the excision of a kidney via a lumbar approach. As per :, an additional 25% premium is payable using code E792 when this procedure is performed laparoscopically. This is a surgical service and includes pre-operative and post-operative care. The fee for the surgeon is for the procedure itself, while fees for an assistant (suffix B) and anaesthetist (suffix C) are calculated based on a combination of basic units and time units.
When to Use
- Use S413 specifically for an open nephrectomy performed via a lumbar approach.
- Use S413 in conjunction with E792 if the procedure is performed laparoscopically, as this is the required mechanism to claim the 25% premium.
Common Pitfalls
- Billing S413 alongside other urogenital procedures without accounting for the multiple procedure rule, which limits basic units for assistants and anaesthetists to the major procedure only.
- Failing to document the lumbar approach specifically, which is required to distinguish S413 from other nephrectomy codes like S415 or S416.
Billing Tips
- Always append E792 on a separate line item to the S413 claim to trigger the 25% laparoscopic premium.
Effective: April 1, 2025
Urogenital and Urinary Surgical Procedures
Kidney and Upper Urinary Tract
Surgical
Urogenital and Urinary Surgical Procedures
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