S543 – Prolapse urethra
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
Surgical procedure for the excision of a prolapsed urethra. The fee for this service includes the surgical procedure itself. Assistant and anaesthesia services are separately calculated based on basic units (6 for assistant, 7 for anaesthesia) plus time units as defined in the - and - of the Schedule of Benefits.
When to Use
- Use S543 for the surgical excision of a symptomatic urethral prolapse that has failed conservative management.
- Use this code for the definitive surgical correction of a prolapsed urethra in an adult patient, distinct from minor office-based procedures.
Common Pitfalls
- Do not bill S543 in conjunction with other urethral procedures unless the work is distinct and separately identifiable, as this may trigger an audit for unbundling.
- Failure to document the specific surgical technique used for the excision can lead to claim rejection if the Ministry requires clarification on the nature of the procedure.
- Attempting to bill an office visit fee on the same day as S543 is generally disallowed unless the visit is for a completely unrelated condition.
Billing Tips
- Ensure the start time of the procedure is accurately recorded to support the application of after-hours premiums (E409/E410) if the surgery occurs outside standard daytime hours.
- When billing for anaesthesia or surgical assistance, ensure the basic units (7 for anaesthesia, 6 for assistant) are correctly applied alongside the time-based units as per the Schedule of Benefits.
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 establish: 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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