S550 – First stage - anterior
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S550 is a surgical procedure for first stage anterior urethroplasty. As a surgical service listed in the Schedule of Benefits, the fee includes pre-operative, intra-operative, and post-operative care as defined in the General Preamble. This service is eligible for billing with suffix A (Surgeon), B (Assistant), and C (Anaesthetist) when the respective services are rendered. It is also subject to general rules for surgical procedures, including After Hours Premiums (E409/E410), Assistant Premiums (E400B/E401B), Anaesthesia Premiums (E400C/E401C), Age-Based Premiums, and the Trauma Premium (E420) under specific conditions.
When to Use
- Use S550 for the initial stage of a planned multi-stage anterior urethroplasty, such as the creation of a perineal urethrostomy or the initial flap/graft placement.
- Use this code when the procedure is specifically documented as the first stage of a staged reconstruction, distinguishing it from single-stage repairs or later stage closures.
Common Pitfalls
- Billing S550 in conjunction with other definitive urethroplasty codes on the same date for the same site, which will trigger a rejection for unbundling.
- Failing to document the specific 'first stage' nature of the procedure, which can lead to audit scrutiny if the claim appears to be a complete repair.
- Attempting to bill an additional consultation or assessment fee on the same day as the surgery, which is typically included in the surgical fee under the General Preamble.
Billing Tips
- Ensure the operative report explicitly details the surgical steps taken for the first stage to support the use of S550 over more comprehensive urethroplasty codes.
- If the procedure is performed after hours, ensure the start time is clearly documented in the record to justify the addition of E409 or E410 premiums.
Effective: April 1, 2025
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. The record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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