S478 – Cystotomy or cystostomy
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
Cystotomy or cystostomy is a surgical procedure that involves making an incision into the bladder. It is eligible for payment for the surgeon (suffix A), assistant (suffix B), and anaesthesiologist (suffix C).
When to Use
- Use S478 for the creation of a suprapubic cystostomy for urinary diversion in patients where urethral catheterization is contraindicated or failed.
- Use S478 for an open cystotomy performed to facilitate the removal of a large bladder calculus or foreign body that cannot be managed endoscopically.
- Use S478 when performing an open bladder exploration or biopsy that does not meet the criteria for more complex codes like S480 (Cystectomy).
Common Pitfalls
- Do not bill S478 if the procedure is performed endoscopically; S478 is strictly for open surgical incisions into the bladder.
- Avoid billing S478 in conjunction with other major bladder surgeries (e.g., partial cystectomy) as the surgical fee for the more comprehensive procedure typically includes the cystotomy.
- Failure to document the specific clinical indication for the cystostomy (e.g., failed urethral access) can lead to audit rejections if the procedure is deemed medically unnecessary.
Billing Tips
- When billing suffix C for the anaesthesiologist, ensure the 6 basic units are correctly accounted for in the total anaesthesia time calculation to avoid under-billing.
- If the procedure is performed on an emergency basis after hours, ensure the correct non-elective premium (E409A/E410A) is applied to the surgeon's fee to maximize the procedural reimbursement.
Effective: April 1, 2025
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
Payable with suffix 'A' for the surgeon.
When billed with suffix 'B' for an assistant, the service includes 0 basic units.
When billed with suffix 'C' for an anaesthesiologist, the service includes 6 basic units.
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