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S459
S459 – Ureterovaginal fistula
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
Surgical repair of a ureterovaginal fistula.
When to Use
- Use S459 specifically for the surgical repair of a confirmed ureterovaginal fistula, typically identified post-hysterectomy or following pelvic surgery.
- Select S459 when the procedure involves the definitive closure of the abnormal communication between the ureter and the vagina, distinct from simple ureteral reimplantation codes.
Common Pitfalls
- Billing S459 alongside other complex pelvic reconstruction codes without clear documentation of separate, distinct surgical sites may trigger a manual review for unbundling.
- Failure to document the specific etiology of the fistula in the operative report can lead to claims being flagged, as the medical necessity for this specific repair must be clearly established.
Billing Tips
- Ensure that if the procedure is performed after hours, you append the appropriate premium (E409 or E410) to the claim, as these are percentage-based increases on the base fee of $596.95.
- If the patient meets trauma criteria, ensure the Injury Severity Score (ISS) is explicitly recorded in the chart to support the E420 premium, as this cannot be claimed concurrently with after-hours premiums.
Provider Fee$596.95
Surgical Assistant Fee$77.46
Anaesthetist Fee$95.76
Non-Anaesthetist Fee$95.76
Effective: April 1, 2026
Category
T. Urogenital and Urinary Surgical Procedures
Subcategory
UROGENITAL AND URINARY SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Musculoskeletal System 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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