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S597
S597 – Penile prosthesis for impotence
OHIP Urology Code — MALE GENITAL SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving the insertion of a penile prosthesis to treat impotence. This service may involve a standard or an inflatable prosthesis, with an additional fee payable for the latter using E755.
When to Use
- Use S597 for the primary surgical insertion of a penile prosthesis in patients with documented impotence.
- Use S597 in conjunction with E755 specifically when the surgical plan involves the insertion of an inflatable prosthesis rather than a semi-rigid device.
Common Pitfalls
- Failing to append the correct suffix (B for surgical assistant, C for anaesthesia) to the claim, which will result in automatic rejection of the associated support services.
- Attempting to bill E755 as a standalone code; it is strictly an add-on and must be submitted on the same claim as S597 to be processed.
- Assuming after-hours premiums like E409 or E410 apply to elective procedures; these are restricted to non-elective cases or elective procedures delayed by surgical emergencies.
Billing Tips
- Always verify that the inflatable prosthesis add-on E755 is included on the same claim submission as S597 to ensure the flat fee is captured correctly.
- Ensure that for surgical assistance (suffix B) and anaesthesia (suffix C), the documentation clearly supports the base units and time units claimed to avoid audit adjustments.
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