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E010

E010Patient with body mass index (BMI) > 40

OHIP Surgical Assists Code · Schedule of Benefits

An amount is payable for extra units in addition to basic units when an anaesthesiologist administers an anaesthetic to a patient with a body mass index (BMI) greater than 40.

When to Use

  • Use E010C when providing anaesthesia for elective surgeries like joint replacements or bariatric procedures where the patient's BMI is documented as > 40.
  • Apply E010C in conjunction with E032C when performing anaesthesia for colonoscopies on patients meeting the BMI threshold.
  • Use E010C alongside P014C for labour analgesia cases where the patient's BMI exceeds 40, as this is a specific exception to the general exclusion rules.

Common Pitfalls

  • Attempting to bill E010C with P016C or E100C will result in automatic rejection, as these codes are explicitly restricted from receiving extra units.
  • Failing to document the specific height and weight in the anaesthesia record creates an audit risk, as the Ministry requires these metrics to justify the BMI > 40 claim.
  • Billing E010C with procedural sedation codes like E030C or E031C is a common error that leads to claim denials.

Billing Tips

  • Always append the 'C' suffix to E010 when submitting with the primary anaesthesia procedural code to ensure proper processing.
  • Verify that the BMI calculation is based on the patient's current weight and height at the time of the procedure, as historical data may no longer meet the > 40 threshold.

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