S446 – Ureterotomy - lower 1/3
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S446 is a surgical procedure code. As per , surgical codes require a suffix when billed: 'A' for the primary surgeon, 'B' for a surgical assistant, and 'C' for an anaesthetist. The fee for the surgeon is a set amount, while the fees for the assistant and anaesthetist are calculated based on basic units plus time-based units as described in - and - respectively. According to , the service of a second surgical assistant is payable for this procedure, but requires authorization from a medical consultant and submission of a letter from the surgeon outlining the reason the second assistant was required.
When to Use
- Use S446A for the surgical incision of the ureter specifically located in the lower third, distinct from S445 which covers the upper two-thirds.
- Select S446A when performing a ureterolithotomy for a stone impacted in the distal ureter that cannot be managed via endoscopic or lithotripsy techniques.
Common Pitfalls
- Billing S446A without the mandatory 'A' suffix will result in an automatic rejection, as the system requires the surgical role designation.
- Attempting to bill S446A alongside endoscopic procedures like cystoscopy or ureteroscopy for the same pathology may trigger a 'duplicate service' or 'incidental procedure' edit unless distinct clinical indications are documented.
- Submitting a claim for a second surgical assistant without prior medical consultant authorization and the required supporting letter will lead to immediate denial of the assistant's fee.
Billing Tips
- Ensure the operative report explicitly describes the stone or pathology location in the lower third of the ureter to justify the use of S446 over S445.
- If the procedure is performed after hours, remember to append the appropriate after-hours premium code (e.g., E409 or E410) to the claim to ensure the full value of the surgical service is captured.
Effective: April 1, 2025
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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