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S415
S415 – Nephrectomy - Transperitoneal
OHIP Urology Code — Kidney and Upper Urinary Tract · Schedule of Benefits
S415 is the code for a transperitoneal nephrectomy, which is the surgical removal of a kidney via an incision through the peritoneum. The fee for the surgeon (S415A) is a flat rate, while fees for an assistant (S415B) and anaesthetist (S415C) are calculated based on basic units plus time-based units.
When to Use
- Use S415 for a standard transperitoneal nephrectomy where the approach requires entering the peritoneal cavity, distinguishing it from retroperitoneal approaches like S412.
- Select S415 when performing a radical nephrectomy for malignancy where transperitoneal access is necessary for lymph node dissection or vascular control.
Common Pitfalls
- Billing S415 alongside other urological procedures without verifying if the secondary procedure is considered 'included' in the global surgical fee, which leads to automatic rejections.
- Failing to document the specific surgical approach (transperitoneal) in the operative report, which risks a clawback if the claim is audited against a less invasive or retroperitoneal code.
- Incorrectly applying after-hours premiums (E409A/E410A) to the surgeon's fee without confirming the procedure start time meets the strict OHIP definition of 'non-elective' and 'after-hours'.
Billing Tips
- Ensure the surgical assistant (S415B) and anaesthetist (S415C) are billed using their respective time-based units, as these are distinct from the flat-rate surgeon fee (S415A).
- If a second assistant is required for a complex S415 case, you must obtain prior authorization and submit a formal letter of justification from the surgeon to avoid immediate claim denial.
Provider Fee$522.50
Specialist Fee$0.00
Surgical Assistant Fee$87.57
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Category
Urogenital and Urinary Surgical Procedures
Subcategory
Kidney and Upper Urinary Tract
Service Type
Surgical
Code Classes
Urogenital and Urinary Surgical Procedures
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