E447 – Two or more large joints imaged on the same limb
OHIP Surgical Assists Code · Schedule of Benefits
An add-on premium for diagnostic ultrasound of the extremities (J182) when two or more large joints are imaged on the same limb. A “large joint” is defined as the shoulder, elbow, hip, knee, or ankle.
When to Use
- Use E447 when performing a comprehensive ultrasound assessment of both the knee and ankle on the same leg during a single J182 encounter.
- Apply this code when imaging the shoulder and elbow on the same arm to capture the additional complexity of a multi-joint diagnostic study.
Common Pitfalls
- Billing E447 when imaging joints on different limbs, such as a left knee and right ankle, which does not meet the 'same limb' requirement.
- Attempting to claim E447 for small joints like the wrist or digits, as these do not meet the OHIP definition of a 'large joint' for this premium.
- Submitting E447 without the primary J182 code, as E447 is a percentage-based premium that requires the base service to trigger payment.
Billing Tips
- Ensure your diagnostic report explicitly lists the two large joints imaged to provide clear audit evidence for the 25% premium increase on J182.
- Always append the correct suffix (B for technical, C for professional) to both the J182 base code and the E447 premium to ensure proper processing.
Effective: April 1, 2026
Diagnostic Ultrasound
Premium
The imaging must involve at least two of the following large joints on the same limb: shoulder, elbow, hip, knee, or ankle.
For E447, a “large joint” is defined as any of the following: shoulder, elbow, hip, knee, or ankle.
The technical component (H fee) is not eligible for payment if the service is rendered to a hospital in-patient or a patient admitted to the same hospital within 24 hours for the same condition.
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