S470 – Cystoscopy with manipulation and/or removal of calculus and retrograde pyelogram
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
This service, S470, involves performing a cystoscopy to visualize the bladder and ureters, combined with the manipulation or extraction of a urinary stone (calculus). The procedure also includes a retrograde pyelogram if required for diagnostic purposes. This is a surgical procedure and can be billed with suffix A by the surgeon and suffix C by the anaesthesiologist. It is subject to various premiums and add-ons as described in the General Preamble, such as after-hours premiums (E409, E410), anaesthesia extra units, and age-based premiums (see :).
When to Use
- Use S470 when performing a cystoscopy specifically for the manipulation or extraction of a ureteral or bladder stone.
- Use S470 when the procedure includes a retrograde pyelogram for diagnostic visualization during the stone management session.
Common Pitfalls
- Billing S470 in conjunction with other cystoscopic procedures (e.g., S472) for the same site is often rejected as unbundling; ensure the primary procedure is captured by the most comprehensive code.
- Failing to document the specific stone location and the nature of the manipulation, which can lead to audit scrutiny regarding the necessity of the procedure.
- Incorrectly applying after-hours premiums (E409/E410) to elective, non-urgent stone removals that do not meet the 'non-elective' or 'delayed emergency' criteria.
Billing Tips
- Ensure the retrograde pyelogram is documented as part of the procedure, as it is included in the S470 fee and cannot be billed as a separate diagnostic imaging claim.
- If a stent is placed during the same session, check the Schedule of Benefits to determine if a separate code (e.g., S474) is eligible for concurrent billing or if it is considered inclusive of the primary surgical fee.
Effective: April 1, 2025
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
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