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S564
S564 – Transurethral incision or resection of external sphincter
OHIP Urology Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
Transurethral incision or resection of external sphincter - when sole operative procedure
When to Use
- Use S564 when performing a standalone transurethral incision or resection of the external sphincter to treat detrusor-sphincter dyssynergia.
- Select S564 when the procedure is the sole operative intervention performed during the session, as the code explicitly specifies 'when sole operative procedure'.
Common Pitfalls
- Billing S564 in conjunction with other urological procedures (e.g., TURP or bladder neck incision) is a common rejection reason, as the code is restricted to 'sole operative procedure' status.
- Failure to document the specific clinical indication for the sphincterotomy can lead to audit recovery, as the necessity must be clearly established in the operative report.
Billing Tips
- Ensure no other surgical procedure codes are submitted on the same claim, as the 'sole operative procedure' requirement is strictly enforced by the Ministry.
Provider Fee$348.80
Anaesthetist Fee$95.76
Non-Anaesthetist Fee$95.76
Effective: April 1, 2026
Category
T. Urogenital and Urinary Surgical Procedures
Subcategory
UROGENITAL AND URINARY SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
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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