E476 – Removal of symptomatic loose body(ies) and/or screw
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
E476 is a surgical procedure for the removal of symptomatic loose body(ies) and/or screw from the knee. A note on specifies that the removal of iatrogenic loose body(ies) is not an eligible service for payment under this code. As a surgical procedure, it is eligible for various premiums including those for after-hours service (E409, E410), trauma (E420), and age-based premiums for patients under 16.
When to Use
- Use E476 for the arthroscopic or open removal of symptomatic loose bodies (e.g., osteochondral fragments) that are causing mechanical symptoms in the knee.
- Use E476 for the removal of retained hardware, such as a symptomatic screw from a previous orthopedic fixation, provided the removal is not necessitated by an iatrogenic error.
Common Pitfalls
- Claims for the removal of loose bodies created during the current surgical procedure (iatrogenic) will be rejected as they are considered part of the primary procedure.
- Failure to clearly distinguish between a loose body removal and a formal debridement or synovectomy can lead to audit scrutiny if the documentation does not support the specific removal of a discrete symptomatic object.
- Attempting to bill E476 in conjunction with other major knee procedures without verifying if the other codes include the removal of loose bodies as an inherent component.
Billing Tips
- Ensure the operative report explicitly documents the symptomatic nature of the loose body or screw to justify the necessity of the removal.
- If the procedure is performed as part of a trauma case, ensure the Injury Severity Score (ISS) is documented in the medical record to support the E420 trauma premium.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Removal of iatrogenic loose body(ies) is not eligible for payment.
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