E446 – Peripheral joint injection using image guidance following a failed blind attempt
OHIP Surgical Assists Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Peripheral joint injection using image guidance following a failed blind attempt, to G370 or G371. Note: 1. For the purpose of G328 and G329, a joint is defined as complex only if it is: a. a joint other than the knee; or b. a knee joint in which the anatomy is distorted by disseminated lupus erythaematosus, dermatomyositis, rheumatoid arthritis, Still's disease, ankylosing spondylitis or other seronegative spondyloarthropathies. 2. E446 is only eligible for payment when injection of the joint must be repeated using any method of image guidance following a failed blind attempt(s) by the same or different physician. Professional and/or technical fees for obtaining and interpreting the images required for the purpose of guidance of the injection are not eligible for payment to any physician.
When to Use
- Use E446 as an add-on code when you perform a joint injection under ultrasound or fluoroscopy specifically because a previous blind attempt by you or another provider was unsuccessful.
- Apply this code when the clinical documentation explicitly confirms the initial blind injection attempt failed to achieve intra-articular placement, necessitating a second, image-guided procedure on the same day or a subsequent visit.
Common Pitfalls
- Billing E446 for a primary image-guided injection; it is strictly an add-on code for a 'failed blind attempt' and will be rejected if the initial attempt is not documented.
- Attempting to bill a separate diagnostic imaging fee (e.g., ultrasound guidance) alongside E446, which is strictly prohibited as the image guidance is considered part of the procedure.
- Failing to link E446 to the primary injection code (G370, G371, G328, or G329) on the same claim, which is required for the add-on to process correctly.
Billing Tips
- Ensure your clinical note explicitly states 'failed blind attempt' to satisfy the specific audit requirement for E446, as this is the primary trigger for the Ministry to validate the add-on fee.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
E446 is only eligible for payment when injection of the joint must be repeated using any method of image guidance following a failed blind attempt(s) by the same or different physician.
For the purpose of G328 and G329, a joint is defined as complex only if it is: a. a joint other than the knee; or b. a knee joint in which the anatomy is distorted by disseminated lupus erythaematosus, dermatomyositis, rheumatoid arthritis, Still's disease, ankylosing spondylitis or other seronegative spondyloarthropathies.
E446 is only eligible for payment when injection of the joint must be repeated using any method of image guidance following a failed blind attempt(s) by the same or different physician. Professional and/or technical fees for obtaining and interpreting the images required for the purpose of guidance of the injection are not eligible for payment to any physician.
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