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T460
T460 – T460
OHIP Other Code · Schedule of Benefits
When to Use
- Use T460 for the definitive surgical repair of a complex abdominal wall hernia, such as an incisional or recurrent hernia requiring mesh placement.
- Select T460 when the procedure involves significant dissection or reconstruction that exceeds the complexity of a standard primary inguinal hernia repair billed under T462 or T463.
Common Pitfalls
- Billing T460 in conjunction with other hernia repairs (e.g., T462) is often rejected as 'incidental' unless the procedures are performed on distinct anatomical sites with separate incisions.
- Failure to document the specific complexity or size of the defect can lead to downgrades during manual audit, as T460 is reserved for more extensive repairs than basic herniorrhaphy codes.
Billing Tips
- Ensure the operative report explicitly details the use of prosthetic mesh or complex fascial closure techniques to justify the higher fee associated with T460 compared to simpler hernia codes.
Provider Fee$896.99
Specialist Fee$896.99
Effective: April 1, 2025
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