S551 – Suture of rupture, anterior urethra
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S551 represents the surgical procedure for the excision of a lesion of the penis with subsequent graft reconstruction. The fee associated with the surgeon (suffix A) is comprehensive and includes the necessary pre-operative assessment (the 'major pre-operative visit' where the decision to operate is made) and routine post-operative care. Separate fees are calculated for the surgical assistant (suffix B) and the anaesthetist (suffix C), based on a system of basic units and time units as outlined in the Schedule of Benefits. See the General Preamble for detailed rules on surgical services (-).
When to Use
- Use S551A for the surgical repair of a traumatic anterior urethral rupture requiring graft reconstruction.
- Use S551A when performing a formal excision of a penile lesion that necessitates a graft for subsequent reconstruction.
Common Pitfalls
- Billing S551A alongside a separate consultation or assessment fee is a common audit trigger, as the fee is comprehensive and includes the major pre-operative visit.
- Attempting to bill for a second surgical assistant without prior authorization and a supporting letter from the surgeon will result in automatic rejection, as S551 is not on the pre-approved list for second assistants.
Billing Tips
- Ensure the Trauma Premium (E420) is only applied if the Injury Severity Score (ISS) is documented in the chart and meets the age-specific thresholds (ISS > 15 for age 16+, ISS > 12 for under 16).
- If the procedure is cancelled after anaesthesia induction but before surgery begins, bill E006B for the assistant and E006C for the anaesthetist rather than attempting to claim the primary procedure code.
Effective: April 1, 2025
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Male Genital Surgical Procedures
Male
Surgical codes require a suffix to identify the role of the physician: Suffix A for the surgeon, Suffix B for the assistant, and Suffix C for the anaesthetist.
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