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S537
S537 – Urethral papilloma, single or multiple
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
This service is for the surgical removal of single or multiple urethral papillomas. The procedure is eligible for anaesthesia, with the anaesthetic fee calculated using 6 base units plus time units as per the rules outlined on of the Schedule. Assistant services are not eligible for payment.
When to Use
- Use S537 for the surgical removal of urethral papillomas when the pathology is specifically identified as papilloma, distinguishing it from general urethral dilation or stricture management (S541).
- Use this code for both single and multiple papilloma removals, as the fee is inclusive regardless of the number of lesions treated during the same session.
Common Pitfalls
- Do not bill S537 in conjunction with urethral dilation (S541) or other urethral procedures unless they are distinct, medically necessary procedures performed at separate sites or for separate indications, as this is a common audit trigger for unbundling.
- Assistant services are strictly ineligible for S537; attempting to claim an assistant fee will result in automatic rejection.
Billing Tips
- Ensure the anaesthesia claim correctly utilizes the 6 base units plus time units, as failure to specify the correct base unit count for S537 will lead to underpayment or rejection of the anaesthesiologist's claim.
- If the procedure is performed on a patient under 16 years of age, remember to append the appropriate age-based fee premium to the S537 procedural fee to maximize the claim value.
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