S552 – Posterior urethra - immediate repair
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S552 represents a radical resection for the excision of a bone tumour located in the shaft or metaphysis of a long bone. The fee for the surgeon (suffix A) is a set amount. The fees for the surgical assistant (suffix B) and anaesthetist (suffix C) are calculated based on basic units plus time-based units, as detailed in the Schedule of Benefits. This service includes all standard components of a surgical procedure, including pre-operative assessment, the operation itself, and post-operative care.
When to Use
- Use S552 for the definitive surgical repair of a posterior urethral injury, typically following trauma or pelvic fracture.
- Select S552 when performing an immediate reconstruction or anastomosis of the posterior urethra, distinguishing this from simple catheterization or endoscopic procedures.
Common Pitfalls
- Billing S552 alongside other urological procedures without verifying if the other services are considered 'included' in the global surgical fee.
- Failure to document the specific nature of the 'immediate repair' in the operative report, which is required to justify the S552 fee over less invasive codes.
Billing Tips
- Ensure the operative report clearly details the complexity of the repair to support the S552 claim, as this code is subject to audit for medical necessity.
- If a second assistant is required for this procedure, you must obtain prior authorization from a medical consultant, as S552 is not on the pre-approved list for a second assistant.
Effective: April 1, 2025
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record 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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