S525 – Rectovesical fistula closure
OHIP Urology Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical procedure listed in the Musculoskeletal System section of the OHIP Schedule of Benefits. Payment is based on a fee-for-service model for the surgeon, and a unit-based system for assistant and anaesthetist services. The fee for the surgeon is inclusive of pre-operative and post-operative care. Additional premiums may be applicable for services rendered after hours, to pediatric or elderly patients, or in cases of significant trauma or complexity as outlined in the General Preamble ().
When to Use
- Use S525 for the definitive surgical closure of a rectovesical fistula, typically performed in a hospital setting.
- Use this code when the procedure is the primary surgical intervention, as it is inclusive of standard pre-operative and post-operative care.
Common Pitfalls
- Attempting to bill a second surgical assistant automatically; S525 is not on the pre-approved list and requires a formal letter of justification to a medical consultant for approval.
- Failing to document the Injury Severity Score (ISS) when attempting to apply the E420 trauma premium, which is a common cause for claim rejection.
- Incorrectly billing after-hours premiums (E409/E410) for elective cases; these are strictly reserved for non-elective procedures or elective cases delayed by an intervening surgical emergency.
Billing Tips
- Ensure the start time of the procedure is accurately recorded, as this is the sole determinant for eligibility for after-hours premiums (E400B/E400C/E401B/E401C).
Effective: April 1, 2026
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM 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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