All codes
T559
T559 – T559
OHIP Other Code · Schedule of Benefits
When to Use
- Use T559 for the surgical repair of a complex or recurrent ventral hernia requiring mesh reinforcement where the defect size or complexity exceeds the criteria for simpler codes like T557.
- Apply this code when performing an open incisional hernia repair that involves extensive adhesiolysis and component separation techniques.
Common Pitfalls
- Billing T559 in conjunction with other hernia repair codes for the same site will trigger a rejection for unbundling, as the fee is intended to be comprehensive.
- Failure to document the specific dimensions of the hernia defect and the use of prosthetic mesh often leads to recovery during Ministry audits.
Billing Tips
- Ensure the operative report explicitly details the complexity of the repair, such as the need for mesh or component separation, to justify the higher fee compared to standard hernia codes.
Provider Fee$1,321.18
Specialist Fee$1,321.18
Effective: February 1, 2011
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