What are the billing rules for S251A?

E811 adds 25% for recurrent fistulae, to S250 or S251 (S28). The surgeon can't bill the hospital or day care admission assessment unless it is the major pre-operative visit (SP2). When another procedure is done under the same anaesthetic, or within 14 days in the same admission for the same condition, the major procedure is paid in full and the others at 85% (SP2).

What is S251A often billed with?

E811 for a recurrent fistula (S28). A035 consultation or A034 partial assessment by the general surgeon at the major pre-operative visit (SP2, A107).

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Billing code

S251A — Fistula-in-ano: Seton drain and/or fistulotomy

Q: What is OHIP billing code S251A?

Fistula-in-ano: exploration of the tract with Seton drain insertion and/or fistulotomy. Add E811 (+25%) for a recurrent fistula.

Anal fistula seton or fistulotomy

Bill S251 for exploring an anal fistula tract with Seton drain insertion and/or fistulotomy.

Watch for: Add E811 (+25%) when the fistula is recurrent.

Provider	Specialist	Assistant	Anaesthetist	Non-anaesthetist
$234.45	$0.00	$77.46	$95.76	$95.76

Code: S251A
Description: Fistula-in-ano: Seton drain and/or fistulotomy
FHO+ basket: Not in the FHO+ base rate basket (Schedule 2 or 2B).
Effective date: Apr 1, 2026
Termination date: No end date

Explanation

Updated October 26, 2026

Fistula-in-ano: exploration of the tract with Seton drain insertion and/or fistulotomy. Add E811 (+25%) for a recurrent fistula.

What it covers

S251 is exploration of a fistula-in-ano tract with insertion of a Seton drain and/or fistulotomy (S28). Definitive repair by LIFT or endorectal advancement flap is S250 (S28).

Like all surgical services, the fee includes preparing the patient, the procedure, recovery room care, and arranging follow-up care until the first post-operative visit (SP1). The major pre-operative visit, where the decision to operate is made, isn't part of the surgical fee and is billed separately (SP2).

Billing rules

E811 adds 25% for recurrent fistulae, to S250 or S251 (S28).
The surgeon can't bill the hospital or day care admission assessment unless it is the major pre-operative visit (SP2).
When another procedure is done under the same anaesthetic, or within 14 days in the same admission for the same condition, the major procedure is paid in full and the others at 85% (SP2).
Surgical assistant: 6 basic units (B suffix); anaesthesia: 6 basic units (C suffix) (S28).
Age premiums apply for patients under 16 (GP64).
Marked '#': the fee doesn't include premises, equipment, supplies or staff, which are funded by the hospital budget or ICHSC facility costs; patients can't be charged for them (GP13).

Often billed with

E811 for a recurrent fistula (S28).
A035 consultation or A034 partial assessment by the general surgeon at the major pre-operative visit (SP2, A107).

Related codes: S250, E811, S247, Z757, Z543, A035

Source: Schedule of Benefits (July 1, 2026), Digestive System Surgical Procedures, Rectum, page S28; Surgical Preamble SP1-SP2; age premiums GP64.

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