E496 – Repair medial or lateral meniscus
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Repair of the medial or lateral meniscus of the knee, which includes debridement of the attachment site when this is rendered. Trimming of a meniscus does not constitute this service.
When to Use
- Use E496 when performing a formal repair (e.g., suture repair) of a torn medial or lateral meniscus that requires stabilization.
- Use E496 when the procedure includes the necessary debridement of the meniscus attachment site to facilitate healing.
Common Pitfalls
- Billing E496 for simple meniscectomy or trimming is incorrect, as these do not meet the definition of a repair and are not eligible for this code.
- Attempting to bill E495 (meniscectomy) in addition to E496 for the same meniscus will result in a rejection, as these are mutually exclusive for the same site.
- Submitting E489, E494, or E498 alongside E496 is prohibited, as the debridement of the attachment site is considered inclusive to the E496 fee.
Billing Tips
- Ensure the operative report explicitly details the repair technique (e.g., inside-out, outside-in, or all-inside sutures) to support the use of E496 over simple debridement codes.
- If performing repairs on both the medial and lateral meniscus, ensure the claim reflects the bilateral nature of the work, noting that E496 is specific to the repair of a single meniscus.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
In order to be eligible for payment, all insured services must be documented in appropriate medical records, establishing that the service was provided, is the service for which the account is submitted, and was medically necessary. An operative report is typically required for surgical procedures.
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