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E440
E440 – Epidural or spinal injection with injection of contrast using fluoroscopy
OHIP Surgical Assists Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
When to Use
- Use E440 when performing a lumbar (G246), thoracic (G117), cervical (G119), or caudal (G918) epidural injection where fluoroscopic guidance is utilized to confirm needle placement via contrast injection.
- Apply this code specifically when the clinical documentation confirms the use of contrast media to verify the epidural space, distinguishing the procedure from non-fluoroscopic or non-contrast guided injections.
Common Pitfalls
- Billing E440 without a corresponding parent code (G246, G117, G119, or G918) on the same claim will result in an automatic rejection.
- Attempting to bill E440 alongside G236, G234, or G920 for the same clinical indication will trigger a rejection, as these are restricted same-day services unless treating a separate, distinct condition.
- Exceeding the 12-service limit for the combined parent codes (G246, G117, G119, G918) within a 12-month period without prior MOH authorization will lead to claim denials.
Billing Tips
- Always link E440 to the primary epidural procedure code in your billing software to ensure the add-on status is correctly processed by the MOH.
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