E491 – Lateral release
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the lateral release of the knee, listed under Musculoskeletal System Surgical Procedures. As per the Schedule of Benefits, this service includes all common elements of insured services (, ) and the specific elements applicable to surgical procedures, such as pre-operative preparation, performance of the procedure, and immediate post-operative care. This procedure must be rendered personally by the surgeon.
When to Use
- Use E491 for an isolated arthroscopic or open lateral retinacular release performed to address patellar maltracking.
- Use E491 when performing a lateral release as a standalone procedure; if performed in conjunction with a more extensive procedure like an arthroscopic meniscectomy (E476) or reconstruction, ensure you are not double-billing components already included in the primary procedure.
Common Pitfalls
- Billing E491 alongside other knee arthroscopy codes (e.g., E476, E492) often triggers a rejection or audit if the lateral release is considered an integral part of the primary surgical approach.
- Failing to document the specific clinical indication for the lateral release, such as objective patellar tilt or lateral subluxation, can lead to recovery of funds during a post-payment audit.
Billing Tips
- If the lateral release is performed as part of a larger knee reconstruction, check the Schedule of Benefits to determine if the release is considered 'included' in the primary code’s fee rather than a separate billable service.
- Ensure the procedure is performed personally by the surgeon, as E491 does not permit delegation to a surgical assistant for the primary billing claim.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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