S429 – Ruptured or lacerated kidney - repair or removal
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S429A covers the surgical repair or complete removal of a kidney that has been ruptured or lacerated. The fee for this service is for the primary surgeon's work. Assistant and anaesthetist services are also payable and are calculated based on units: - Anaesthesia: 7 basic units plus time units as per the rules on . - Assistant: 7 basic units plus time units as per the rules on . As per , a second surgical assistant's services are payable for this procedure without special authorization.
When to Use
- Use S429A for the surgical repair of a traumatic renal laceration identified during an exploratory laparotomy.
- Use S429A for a nephrectomy performed specifically due to a ruptured kidney resulting from blunt or penetrating trauma.
Common Pitfalls
- Billing S429A for elective nephrectomies (e.g., for malignancy) is incorrect; this code is strictly for ruptured or lacerated kidneys.
- Failing to document the Injury Severity Score (ISS) in the medical record will lead to the rejection of the E420 trauma premium.
- Attempting to claim after-hours premiums (E409A/E410A) in addition to the E420 trauma premium is prohibited, as they are mutually exclusive.
Billing Tips
- Ensure the second surgical assistant is billed using the same logic as the first, as S429A explicitly allows for a second assistant without prior authorization.
- When performing this procedure on a trauma patient, verify that the ISS is documented in the chart to support the 50% E420 trauma premium.
Effective: April 1, 2025
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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