S189

PDF page 104 / GP90

SECOND ASSISTANT
Payment rules:
When more than one assistant was required for a surgical procedure, unless the service is listed
below, the second assistant’s service is only eligible for payment following authorization by a medical
consultant and requires submission of a letter from the surgeon outlining the reason the second
assistant was required. The amount payable for the second assistant is calculated in the same
manner as the amount payable for the first assistant.
Services where a second assistant's services are payable and authorization is not required:
D043, D046, D047, D052, D060, E645, F135, M112, M117, M134, M142, N539, N540, P042, P051,
P052, P056, P059, R008, R009, R013, R014, R015, R016, R055, R056, R064, R065, R067, R069,
R134, R135, R136, R140, R182, R240, R241, R244, R326, R327, R334, R393, R438, R440, R441,
R483, R487, R545, R553, R568, R593, R594, R617, R645, R701, R702, R704, R712, R713, R714,
R715, R718, R726, R727, R728, R729, R732, R733, R734, R735, R737, R739, R742, R743, R746,
R747, R749, R764, R770, R771, R772, R773, R774, R786, R799, R800, R801, R802, R803, R804,
R811, R815, R817, R818, R830, R832, R858, R863, R870, R872, R874, R876, R927, R929, R920,
R930, S005, S007, S079, S090, S091, S092, S096, S098, S099, S120, S125, S189, S210, S211,
S213, S214, S267, S270, S271, S274, S275, S294, S295, S298, S300, S321, S416, S429, S440,
S441, S453, S454, S462, S484, S750, S757, S758, S759, S816
       [Commentary:
       E003B is not eligible for payment for second assistant services.]

PDF page 548 / SP6

SURGICAL PREAMBLE
PREAMBLE
 24. Morbidly obese patients
     E676 is eligible for payment once per patient per physician in addition to the amount eligible for
     payment for the major surgical procedure(s) where a morbidly obese patient undergoes major
     surgery to the neck, thorax, peritoneal cavity, retroperitoneum, pelvis, or hip and:
    a. the patient has a Body Mass Index (BMI) greater than 40
    b. the surgery is rendered under general anaesthesia using either an open technique for the
       neck, thorax, or hip, or an open or laparoscopic technique for the peritoneal cavity, pelvis,
       retroperitoneum; and
    c. the principal surgical technique is neither aspiration, core or fine needle biopsy, dilation,
       endoscopy, mediastinoscopy, thoracoscopy, cautery, ablation nor catheterization.
E676A Morbidly obese patient, surgeon, to procedural fee(s)...... add                      25%
E676B Morbidly obese patient, surgical assistant, to major procedure
        add                                                                               6 units
     Note:
     E676A/B is only payable with the following procedures: D043, D046, D047, D052, E090, E499,
     E500, E505, E546, E589, E593, E626, E627, E655, E664, E673, E686, E697, E704, E706,
     E707, E708, E709, E711, E712, E713, E714, E718, E721, E722, E725, E728, E729, E731,
     E733, E734, E735, E736, E737, E738, E739, E743, E745, E748, E752, E754, E762, E764,
     E765, E766, E767, E768, E769, E771, E794, E796, E852, E853, E854, E855, E857, E860,
     E880, E882, E883, E884, E885, F100, F101, F135, M081, M082, M084, M090, M099, M100,
     M142, M143, M144, P018, P041, P042, P050, P055, P056, P057, P058, P059, P060, R108,
     R109, R216, R241, R269, R330, R423, R439, R440, R443, R470, R481, R488, R491, R553,
     R569, R590, R627, R628, R639, R686, R786, R800, R802, R803, R805, R806, R807, R811,
     R814, R815, R817, R823, R825, R826, R834, R839, R852, R855, R856, R858, R860, R861,
     R910, R885, R905, R913, R914, R915, R932, R933, R934, R935, R936, R937, S089, S090,
     S114, S115, S116, S117, S118, S120, S121, S122, S123, S124, S125, S128, S129, S131,
     S132, S133, S134, S137, S138, S139, S140, S149, S150, S154, S157, S158, S159, S160,
     S162, S164, S165, S166, S167, S168, S169, S170, S171, S172, S173, S175, S176, S177,
     S180, S182, S183, S184, S185, S187, S188, S189, S191, S192, S193, S194, S195, S196,
     S197, S199, S204, S207, S213, S214, S215, S217, S218, S222, S227, S265, S266, S267,
     S269, S270, S271, S274, S275, S276, S278, S280, S281, S282, S285, S287, S291, S292,
     S294, S295, S297, S298, S299, S300, S301, S302, S303, S304, S305, S306, S307, S308,
     S309, S310, S311, S312, S313, S314, S315, S318, S319, S321, S323, S325, S329, S332,
     S340, S342, S343, S344, S345, S405, S411, S416, S420, S422, S424, S427, S431, S432,
     S433, S434, S435, S436, S438, S440, S441, S445, S446, S447, S448, S449, S450, S451,
     S452, S453, S454, S455, S457, S460, S461, S462, S465, S466, S467, S468, S471, S482,
     S483, S488, S490, S491, S512, S513, S546, S549, S561, S590, S650, S651, S652, S710,
     S714, S727, S728, S729, S731, S733, S735, S736, S738, S739, S740, S741, S743, S745,
     S747, S748, S750, S751, S757, S758, S759, S760, S761, S763, S764, S766, S775, S776,
     S778, S780, S781, S782, S784, S788, S789, S790, S792, S793, S795, S798, S799, S800,
     S813, Z427, Z526, Z552, Z553, Z564, Z569, Z577, Z594, Z737, Z738

PDF page 549 / SP7

28. Bariatric surgery
         S120 (gastric bypass or partition), S189 (intestinal bypass) and S114 (sleeve gastrectomy) are
         insured services only when all of the following criteria are satisfied:
         1.The surgery has been proposed for an indication supported by clinical practice guidelines
           adopted by the Canadian Association of Bariatric Physicians and Surgeons at the time of the
           surgery
         2.The patient has attempted weight loss in the past without successful long-term weight
           reduction; and
         3.The patient has been recommended for the surgery by a multidisciplinary team at a Bariatric
           Regional Assessment and Treatment Centre in Ontario.

PDF page 695 / S13

DIGESTIVE SYSTEM SURGICAL PROCEDURES
 STOMACH
                                                                                              Asst   Surg     Anae
    Vagotomy
# S131 - truncal or selective .............................................................    7     375.80    7
# S124 - highly selective (as sole procedure without pyloroplasty or
         gastroenterostomy) ............................................................       7     572.85    7
# S121 Transabdominal vagotomy after previous vagotomy ..............                          7     416.50    8
      Note:
      For suture of duodenal ulcer, refer to S139 on next page.
# S120 Gastric bypass with Roux-en-Y anastomosis, for morbid
           obesity ................................................................................ 7 1350.00 10
# S115 Reversal of previous vertical banded gastroplasty .................                          7  820.00 10
# S114 Sleeve gastrectomy ................................................................          7  820.00 10
      Note:
      1.S114 Sleeve gastrectomy is only eligible for payment when:
          a.a Roux-en-Y gastric bypass is not possible due to small bowel disease/adhesions or
            previous surgery; or
          b.performed as a planned staged surgery in patients with a BMI > 60 to enable the patient
            to lose weight.
      2.S120 is an insured service only when all of the conditions set out in the Surgical Preamble
        are satisfied.
      3.S189 is not eligible for payment in conjunction with S120.
      4.S160 is not eligible for payment in conjunction with S120.
      5.Mini-gastric bypass (loop gastric bypass) does not constitute gastric bypass or partition for
        the purpose of S120.
         [Commentary:
         The second stage would be a gastric bypass with Roux-en-Y.]
# S113 Removal of gastric band ........................................................ 7 341.60               10
      Note:
      S113 is only eligible for payment when the gastric band requires removal due to:
      1.Complications related to the gastric band; or
      2.Conversion to gastric bypass.
# E793        - laparoscopic or laparoscopic assisted, to S113, S114,
                S115 or S120 ..................................................... add 25%
         [Commentary:
         1.S120 does not include the service described as adjustable gastric banding by laparoscopic
           or open surgical method. See section 37.1 of Regulation 552 under the Health Insurance
           Act.
         2.Morbid obesity refers to patients with a Body Mass Index (BMI) > 40.]

PDF page 703 / S21

DIGESTIVE SYSTEM SURGICAL PROCEDURES
 INTESTINES (EXCEPT RECTUM)
                                                                                                          Asst    Surg     Anae
# S173        - abdominal...........................................................................       9     1812.00    10
# S174        - perineal...............................................................................           533.80
# E738     - with continent ileostomy, to either S168, S169, S170,
             S173 or S174 ............................................................. add                       441.10
   E718    - bowel resection following previous resection with
             anastomosis, or following S217, S213, S214 or S215
             ................................................................................... add              162.15
       Note:
       E718 is not to be added to S181, S182, S185, S191, S192 or S193.
# S188 Bowel resection without anastomosis (colostomy and mucous
         fistula).................................................................................         6      877.40    6
# S189 Intestinal bypass for morbid obesity .......................................                        7      951.20    10
# E793    - laparoscopic or laparoscopic assisted, to S189 add 25%
         Note:
         1.S189 is an insured service only when all of the conditions set out in the Surgical Preamble
           are satisfied.
         2.Mini-gastric bypass (loop gastric bypass) does not constitute intestinal bypass for the
           purpose of S189.
    Intestinal obstruction (mechanical)
      One stage
# S175 - without resection ................................................................                6      814.95    7
# S176 - with entero-enterostomy.....................................................                      6     1023.75    7
# S177 - with resection .....................................................................              6     1207.25    7
# S180 - with enterotomy ..................................................................                6      943.60    7
      Note:
      If staged procedure, refer to Surgical Preamble SP2.
# S178 Intestinal atresia (newborn) ....................................................                   6     1722.55    7
# S179 Meconium ileus.......................................................................               6     1722.55    7
       REPAIR

Master, record 5316. Record Layout PDF, page 1.

S18920260401999999990000951200000000903700000000000000000159600000001596000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.