S466 – Immediate repair of traumatic rupture or transection - lower 1/3
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S466 is for the immediate surgical repair involving suture of a traumatic rupture or partial/complete transection affecting the lower one-third of the ureter. This is a surgical procedure and as such, includes all constituent and common elements as defined in the Schedule of Benefits (-). Payment for assistants and anaesthetists is based on a unit system, combining basic units and time units.
When to Use
- Use S466 for the immediate surgical repair of a traumatic ureteral rupture or transection specifically located in the lower one-third of the ureter.
- Select S466 over S467 if the injury is limited to the lower third, as S467 is designated for middle-third injuries and S468 for upper-third injuries.
Common Pitfalls
- Billing S466 in conjunction with after-hours premiums (E409/E410) and the trauma premium (E420) simultaneously; E420 is mutually exclusive with all after-hours and special visit premiums.
- Failing to document the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium, which leads to automatic rejection or audit recovery.
Billing Tips
- Ensure the surgical report explicitly describes the anatomical location of the injury as the 'lower one-third' to justify the use of S466 over other ureteral repair codes.
- When claiming E420, verify the patient meets the specific age-based ISS thresholds (ISS > 15 for age 16+, ISS > 12 for under 16) to ensure the 50% premium is valid.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
Assistant (B suffix): 6 basic units. ()
Anaesthesia (C suffix): 6 basic units. ()
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