S523 – Vesicovaginal fistula repair - vaginal approach
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S523 is a fee code for a surgical procedure. As a surgical service, it is eligible for various add-on premiums, including those for age, after-hours services, and trauma, subject to specific criteria outlined in the General Preamble. The fee for the surgeon (suffix A), assistant (suffix B), and anaesthetist (suffix C) are calculated based on basic and time units, with specific rules for each role.
When to Use
- Use S523 specifically for the surgical repair of a vesicovaginal fistula via the vaginal route.
- Select S523 when the procedure is performed as a primary repair or a repeat repair via the vaginal approach, distinguishing it from abdominal approaches which may fall under different surgical fee categories.
Common Pitfalls
- Billing S523 in conjunction with other major pelvic floor repairs without checking for 'incidental' or 'included' procedure rules in the Schedule of Benefits, which may lead to claim rejection for unbundling.
- Failure to document the specific vaginal approach, as billing S523 when an abdominal approach was actually performed is a common audit trigger for miscoding.
Billing Tips
- Ensure that if an assistant or anaesthetist is involved, their claims (suffix B and C) are submitted with the corresponding after-hours premiums (E400B/C or E401B/C) only if the case start time meets the specific criteria defined in the General Preamble.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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