S553 – Late repair of posterior urethra
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S553 is a surgical procedure from the Urogenital System section of the Schedule of Benefits. Claims are submitted with suffix A for the surgeon, B for the assistant, and C for the anaesthetist. The fees for the assistant and anaesthetist are calculated based on basic and time units. This procedure is specifically noted as one where a second surgical assistant's services are eligible for payment without requiring authorization by a medical consultant. It is also eligible for various after-hours, age-based, and trauma premiums.
When to Use
- Use S553 for the definitive surgical reconstruction of a posterior urethral stricture or defect that has developed following an initial injury or prior surgical intervention.
- Select S553 when performing a delayed repair, specifically distinguishing it from acute primary repairs or minor endoscopic urethrotomies like those coded under the R-series.
Common Pitfalls
- Do not bill S553 in conjunction with endoscopic procedures like internal urethrotomy; these are generally considered components of the repair or separate procedures that may trigger bundling edits.
- Failure to document the specific 'late' or 'delayed' nature of the repair can lead to audit scrutiny if the claim is mistaken for an acute trauma repair.
- Ensure the second surgical assistant is billed under the same claim; while authorized, the claim must clearly reflect the necessity of the second assistant to avoid manual review delays.
Billing Tips
- Since S553 is explicitly eligible for a second surgical assistant without prior authorization, ensure the second assistant's claim is submitted with suffix B and the appropriate premium codes to maximize reimbursement.
- If the procedure is performed as a non-elective case due to complications, ensure the appropriate Special Visit Premium (C-series) is linked to the first patient seen to avoid rejection.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
Services where a second assistant's services are payable and authorization is not required.
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