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E011C
E011C – Patient in prone position during surgery
OHIP Surgical Assists Code — GENERAL PREAMBLE · Schedule of Benefits
An amount is payable for 4 extra units in addition to basic anaesthesia units when an anaesthesiologist administers an anaesthetic to a patient in a prone position during surgery. These extra units are not eligible for payment with certain services such as procedural sedation for nerve blocks (E030C), general anaesthesia for nerve blocks (E031C), or supportive care/monitoring (E003C).
When to Use
- Use E011C when the patient is placed in the prone position for spinal surgery, such as a laminectomy or discectomy, to account for the increased complexity of airway management.
- Apply this code for posterior approach surgeries where the patient is prone, such as complex orthopedic procedures on the lower extremities or back, provided the patient is not under a restricted service like E003C.
Common Pitfalls
- Billing E011C alongside E003C is a common rejection trigger, as the Ministry explicitly prohibits combining prone position premiums with supportive care or monitoring services.
- Attempting to claim E011C during nerve block procedures (E030C or E031C) will result in automatic claim rejection due to the specific exclusions listed in the General Preamble.
- Failing to ensure the total anaesthesia time units are calculated correctly before adding the 4 units for E011C often leads to audit discrepancies.
Billing Tips
- Ensure your operative report explicitly states the patient was positioned prone, as this serves as the primary documentation requirement for audit verification of the 4 extra units.
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