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T465
T465 – T465
OHIP Other Code · Schedule of Benefits
When to Use
- Use T465 for the surgical management of a complex pelvic floor reconstruction involving the repair of a vesicovaginal or urethrovaginal fistula.
- Apply this code when performing a primary surgical closure of a high-complexity genitourinary fistula that requires extensive dissection beyond standard simple repairs.
- Select T465 instead of minor gynecological procedure codes when the surgical complexity necessitates a formal, multi-layered reconstructive approach.
Common Pitfalls
- Billing T465 in conjunction with standard gynecological examination codes or minor diagnostic procedures that are considered bundled into the global surgical fee.
- Failure to provide sufficient operative details regarding the complexity of the fistula repair, which may trigger a manual review or audit for unbundling.
- Attempting to bill T465 alongside other major pelvic surgeries without appropriate modifier usage or documentation of distinct, separate procedures.
Billing Tips
- Ensure the operative report explicitly details the layers of closure and the anatomical complexity to justify the high-value fee associated with T465.
- Review the Schedule of Benefits for specific exclusions regarding concurrent procedures, as T465 often includes the global period for post-operative care.
Provider Fee$1,001.19
Specialist Fee$1,001.19
Effective: April 1, 2025
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