S468 – Late repair - lower 1/3
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
Late repair for a traumatic rupture, or partial or complete transection, involving the lower one-third of the ureter. This is a surgical procedure.
When to Use
- Use S468 for the delayed surgical repair of a ureteral injury occurring in the distal third of the ureter, typically identified days or weeks after the initial trauma or iatrogenic event.
- Select S468 when the procedure involves definitive reconstruction or repair of a ureteral transection or rupture in the lower segment, distinguishing it from S465 or S466 which apply to upper or middle segments.
Common Pitfalls
- Billing S468 for an acute, primary repair performed at the time of the initial injury; this code is specifically for 'late' repairs, whereas primary repairs often fall under different procedural descriptors.
- Failure to document the specific anatomical location of the ureteral injury, which can lead to audit rejections if the claim is flagged for review and the 'lower 1/3' designation is not clearly supported by the operative report.
- Attempting to claim the Trauma Premium (E420) without explicit documentation of the Injury Severity Score (ISS) in the patient's chart, which is a mandatory requirement for this premium.
Billing Tips
- Ensure the operative note explicitly describes the 'late' nature of the repair, such as addressing a ureteral stricture or fistula resulting from a prior injury, to justify the use of S468 over primary repair codes.
- If the procedure is performed after hours or involves a trauma patient meeting ISS criteria, ensure all applicable premiums (E409/E410 or E420) are submitted on the same claim as S468 to ensure proper processing.
Effective: April 1, 2026
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 establishing that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary. (Source: :)
If claiming the Trauma Premium (E420), the medical record must list the Injury Severity Score (ISS). (Source: :)
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