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S566
S566 – Revision including removal of prosthesis
OHIP Urology Code — MALE GENITAL SURGICAL PROCEDURES · Schedule of Benefits
This service is for the revision of a penile prosthesis, including the removal of the device, as listed in the Male Genital Surgical Procedures section of the Schedule of Benefits. This procedure is eligible for anaesthesia and assistant fees, which are calculated based on basic units plus time units. See - for detailed rules on surgical assistant and anaesthesiologist services.
When to Use
- Use S566 for the complete removal of a penile prosthesis due to mechanical failure or device malfunction.
- Use S566 when performing a revision that necessitates the total extraction of the existing prosthesis, distinguishing it from simple component adjustments or minor repairs.
Common Pitfalls
- Billing S566 in conjunction with S597 (Penile prosthesis, insertion) for the same operative session without clear documentation of a staged procedure or specific clinical necessity may trigger a rejection.
- Failing to document the specific indication for removal (e.g., infection, erosion, or mechanical failure) is a common audit risk that can lead to claim reversal.
- Attempting to bill a second surgical assistant for this procedure is a frequent error, as S566 is not on the pre-approved list for multiple assistants and requires prior authorization.
Billing Tips
- Ensure the claim includes the specific diagnosis code related to the prosthesis complication to justify the removal procedure.
- If the removal is performed on an emergency basis due to severe infection, ensure the operative report clearly supports the urgency to justify potential after-hours premiums.
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