All codes
T462
T462 – T462
OHIP Other Code · Schedule of Benefits
When to Use
- Use T462 for the surgical repair of a complex or complicated abdominal wall hernia, specifically when involving mesh reinforcement or significant tissue dissection.
- Apply this code when performing a primary repair of a large ventral or incisional hernia that exceeds the complexity criteria for standard hernia repairs like Z311.
Common Pitfalls
- Billing T462 alongside a laparoscopic procedure code is often rejected; ensure the operative report clearly justifies the open approach if a laparoscopic alternative was available.
- Submitting T462 for a simple umbilical or inguinal hernia repair will trigger an audit, as these should be billed under lower-valued codes like Z313 or Z314.
Billing Tips
- Ensure the operative report explicitly details the size of the defect and the specific type of mesh used to support the high-value claim of T462 during a post-payment review.
Provider Fee$1,000.76
Specialist Fee$1,000.76
Effective: April 1, 2025
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