S428 – Symphysiotomy for Horseshoe Kidney with or without Nephropexy and Associated Procedures
OHIP Urology Code — Kidney and Upper Urinary Tract · Schedule of Benefits
Symphysiotomy for horseshoe kidney with or without nephropexy and associated procedures. As per the Schedule of Benefits (), when 'with or without' is used, the associated services (e.g., nephropexy) are optional but included in the fee when rendered.
When to Use
- Use S428 for the surgical division of the isthmus in a horseshoe kidney, regardless of whether a concurrent nephropexy is performed.
- Use this code for the primary procedure when the symphysiotomy is the definitive treatment for obstruction or complications related to the horseshoe anatomy.
Common Pitfalls
- Do not bill separately for a nephropexy performed during the same session, as it is considered an 'associated procedure' included in the S428 fee.
- Avoid billing S428 alongside other major kidney procedures without checking for potential bundling rules, as the Schedule of Benefits often restricts multiple procedure claims for the same anatomical site.
Billing Tips
- Ensure the operative report clearly details the symphysiotomy to justify the code, as the 'with or without' clause makes the documentation of the primary procedure critical for audit purposes.
- If a second surgical assistant is required, you must obtain prior authorization from a medical consultant, as S428 is not on the pre-approved list for second assistant billing.
Effective: April 1, 2025
Urogenital and Urinary Surgical Procedures
Kidney and Upper Urinary Tract
Surgical
Urogenital and Urinary Surgical Procedures
Standard medical record keeping is required as per .
For surgical assistant (suffix B) and anaesthetist (suffix C) claims, the start and stop times must be recorded in the patient's medical record to justify time units claimed (:100, :107).
If claiming the trauma premium (E420), the Injury Severity Score (ISS) must be listed in the medical record ().
with or without nephropexy and associated procedures
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