S556 – Rectourethral fistula repair with diversion, colostomy and closure of colostomy
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
S556 represents a rectourethral fistula repair with diversion, colostomy and closure of colostomy. This is a major surgical procedure involving the repair of a rectourethral fistula, urinary diversion, creation of a colostomy, and subsequent closure of the colostomy. The fee for this procedure includes the surgery itself (suffix A) and routine post-operative care by the surgeon. Assistant (suffix B) and anaesthesia (suffix C) services are billed separately based on a unit system.
When to Use
- Use S556 when performing a definitive repair of a rectourethral fistula that necessitates a concurrent fecal diversion via colostomy.
- Use S556 for the combined surgical event that includes the fistula repair, the creation of the stoma, and the subsequent restoration of bowel continuity.
Common Pitfalls
- Do not bill S556 in conjunction with separate codes for colostomy creation or closure, as these components are inclusive to the S556 fee.
- Avoid billing S556 if the procedure is limited to a simple fistula repair without the required diversion and stoma management components.
- Failure to obtain prior authorization for a second assistant will result in automatic rejection, as the base fee assumes a single assistant.
Billing Tips
- Ensure the operative report explicitly details the fistula repair, the diversion, and the colostomy closure to justify the comprehensive nature of the S556 claim.
- If the procedure qualifies for trauma premiums (E420), ensure the Injury Severity Score is clearly documented in the chart to support the 50% increase.
Effective: April 1, 2026
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
When more than one assistant is required for S556, the second assistant’s service is only eligible for payment following authorization by a medical consultant and requires submission of a letter from the surgeon outlining the reason the second assistant was required.
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