S440 – Cystectomy - with continent urinary diversion
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
A complete cystectomy, which is the surgical removal of the entire urinary bladder, performed with a continent urinary diversion. A continent urinary diversion is a surgical procedure to create a new way for urine to be stored and eliminated from the body, allowing the patient to control urination. This service is eligible for a 25% premium via E792 when performed laparoscopically. This procedure has 15 anaesthesia base units and 9 assistant base units.
When to Use
- Use S440 for a complete cystectomy where a continent urinary diversion (e.g., Indiana pouch or neobladder) is constructed to allow for patient-controlled elimination.
- Select S440 when the procedure is performed as a primary definitive treatment for bladder malignancy requiring total bladder removal and reconstruction.
Common Pitfalls
- Do not bill S440 if the procedure involves a standard ileal conduit (urostomy), as this is not a continent diversion; ensure the documentation clearly specifies the continent nature of the reconstruction.
- Avoid billing S440 in conjunction with other major pelvic resections unless they are distinct, non-overlapping procedures, as the Ministry may flag this for unbundling or duplicate billing.
- Failure to append E792 when the procedure is performed laparoscopically results in a 25% loss of the surgeon's fee.
Billing Tips
- Always confirm the continent diversion type in the operative report to support the use of S440 over less complex urinary diversion codes.
- Ensure the anaesthesia and assistant base units are calculated based on the major procedure (S440) when multiple surgical procedures are performed during the same operative session.
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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