S424 – Extrophy - plastic closure of bladder with closure of abdominal wall and urethral lengthening with closure of pelvic floor with or without reimplantation of ureters
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the repair of bladder exstrophy. It includes plastic closure of the bladder, closure of the abdominal wall, urethral lengthening, and closure of the pelvic floor. The description specifies 'with or without reimplantation of ureters', meaning that if reimplantation of the ureters is performed during the same operation, it is considered part of this service and is not billed separately (). The fee for the surgeon (suffix A) is a flat rate. The service is eligible for an assistant (suffix B) with 7 base units, and an anaesthetist (suffix C) with 10 base units. Time units are calculated in addition to these base units for both assistant and anaesthetist services as per the rules in the General Preamble (-, -).
When to Use
- Use S424 for the primary surgical repair of bladder exstrophy, which encompasses the plastic closure of the bladder and abdominal wall.
- Use this code when urethral lengthening and pelvic floor closure are performed as part of the exstrophy reconstruction, regardless of whether ureteral reimplantation is also required.
Common Pitfalls
- Do not bill ureteral reimplantation separately, as the S424 fee is inclusive of this procedure when performed during the same operative session.
- Failure to document the Injury Severity Score (ISS) in the medical record will result in the rejection of the E420 trauma premium, even if the clinical criteria are met.
- Billing S424 in conjunction with other urogenital reconstruction codes that are considered integral to the exstrophy repair will trigger a rejection for unbundling.
Billing Tips
- Ensure the claim includes the appropriate age-based premium (e.g., under 30 days, under 1 year) to maximize the procedural fee, as these are not automatically applied by the system.
- When billing for the assistant (suffix B) or anaesthetist (suffix C), ensure that time units are calculated and submitted in addition to the specified base units to reflect the full duration of the procedure.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
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