S519 – Plastic repair of bladder neck - adolescent or adult
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
Plastic repair of the bladder neck in an adolescent or adult. This surgical procedure is eligible for payment to the surgeon (suffix A), an assistant (suffix B), and an anaesthetist (suffix C). The fee for a surgical assistant is calculated using 6 base units plus time units. The fee for an anaesthetist is calculated using 7 base units plus time units. Refer to the General Preamble for detailed rules on unit calculation (, ).
When to Use
- Use S519 for formal plastic reconstruction or surgical repair of the bladder neck in patients aged 16 or older.
- Select S519 when the procedure is distinct from simple endoscopic procedures or minor bladder neck incisions (e.g., S518).
Common Pitfalls
- Billing S519 for pediatric patients under 16, which is restricted; ensure the patient meets the age criteria defined in the Schedule.
- Failing to document the specific start and end times for the anaesthetist (suffix C) or the surgical assistant (suffix B), which is required for accurate unit calculation under GP86 and GP93.
- Incorrectly applying after-hours premiums (E409, E410) to elective cases that do not meet the definition of non-elective or delayed emergency procedures.
Billing Tips
- Ensure the surgical assistant and anaesthetist fees are calculated using the correct base units (6 for B, 7 for C) plus the appropriate time units as per the General Preamble.
- Always verify if the patient qualifies for additional anaesthesia units (e.g., E022C for ASA III or E010C for BMI > 40) to maximize the anaesthetist's claim.
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 that the service was provided, is the service submitted, and was medically necessary, as per the Health Insurance Act ().
For surgical assistant services, time spent must be recorded in the patient's permanent medical record ().
For anaesthesia services, the anaesthesiologist's start and end times must be recorded in the patient's medical record ().
Adolescent or adult patient
The fee for a surgical assistant (suffix B) is calculated using 6 base units plus time units.
The fee for an anaesthetist (suffix C) is calculated using 7 base units plus time units.
See the Surgical Assistants' Services (-) and Anaesthesiologists' Services (-) sections of the General Preamble for unit calculation rules.
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