S555 – Fistula - perineal urethra
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S555 is a surgical procedure listed in the Digestive System section of the Schedule of Benefits. As a surgical service, it is subject to the general rules governing surgical procedures, including the use of suffixes 'A' for the surgeon, 'B' for the assistant, and 'C' for the anaesthetist as described on . Payment for assistant and anaesthetist services is calculated based on basic units and time units (, ). Notably, S555 is one of the procedures for which a second assistant's service is eligible for payment without prior authorization from a medical consultant ().
When to Use
- Use S555 for the surgical repair of a perineal urethral fistula when the procedure is performed as a distinct, standalone surgical intervention.
- Use S555 when a second surgical assistant is medically necessary, as this code is pre-approved for second assistant billing without requiring prior authorization from a medical consultant.
Common Pitfalls
- Billing S555 in conjunction with other urogenital procedures without ensuring that the 'major procedure' rules are applied to the anaesthesia and assistant basic units.
- Failing to document the specific anatomical location and complexity of the fistula, which may lead to audit scrutiny regarding the necessity of the surgical approach.
Billing Tips
- If a second assistant is utilized, ensure the claim is submitted with the appropriate suffix 'A' for the primary surgeon and the corresponding assistant codes to trigger the automatic eligibility for the second assistant fee.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Digestive 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.
When a second assistant is required for a surgical procedure, unless the service is listed, the second assistant's service is only eligible for payment following authorization by a medical consultant. S555 is listed as a service where a second assistant's services are payable and authorization is not required.
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