S738 – Salpingectomy or salpingo-oophorectomy
OHIP Urology Code — FEMALE GENITAL SURGICAL PROCEDURES · Schedule of Benefits
S738 is a fee code for a surgical procedure falling under the Urogenital and Urinary Surgical Procedures section of the Schedule of Benefits. Payment for this service includes all constituent elements of an insured service as defined in the General Preamble. This includes: - Common Elements (, ): All preparation, travel, communication, record-keeping, and provision of supplies necessary for the service. - Specific Surgical Elements (): - Preparing or supervising the preparation of the patient for the procedure. - Performing the procedure by any method, assisting with recovery room procedures, and monitoring during the immediate post-operative period. - Making arrangements for related assessments or therapy. - Post-procedure follow-up monitoring until the first post-operative visit. - Discussions and advice to the patient or their representative.
When to Use
- Use S738 for a standalone salpingectomy or salpingo-oophorectomy procedure performed as a primary surgical event.
- Use S738 when performing a prophylactic salpingectomy in conjunction with other non-related procedures, provided the salpingectomy is the primary or co-primary surgical focus.
Common Pitfalls
- Billing a hospital admission assessment or a subsequent hospital visit on the same day as the surgery, which is prohibited as these are included in the global surgical fee.
- Attempting to unbundle the procedure by billing for separate components like tissue removal or minor dissection, which are considered constituent elements of the S738 fee.
- Failing to recognize that S738 is a global fee; claiming additional office visits for routine post-operative follow-up within the global period will result in rejections.
Billing Tips
- If the procedure is performed as part of a larger, more complex surgery, ensure you are not double-billing; if the other procedure has a higher value, bill the primary procedure and check the Schedule of Benefits for rules regarding multiple procedure billing (e.g., 100%/50% rules).
- Always document the specific surgical indication and the extent of the procedure (e.g., unilateral vs. bilateral) to support the claim in the event of a post-payment audit.
Effective: April 1, 2025
V. Female Genital Surgical Procedures
FEMALE GENITAL SURGICAL PROCEDURES
Surgical
Urogenital and Urinary Surgical Procedures
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