All codes
E497
E497 – Pedicled vascularized bone graft
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
When to Use
- Use E497 when performing a scaphoid non-union repair (R322) where a pedicled vascularized graft, such as a 1,2-intercompartmental supraretinacular artery (1,2-ICSRA) graft, is harvested and transferred to the defect.
- Use E497 when performing a carpal bone repair (R345) for avascular necrosis where a pedicled vascularized bone graft is utilized to restore blood supply to the bone fragment.
Common Pitfalls
- Billing E497 as a standalone procedure; it is strictly an add-on code and will be rejected unless submitted with R322 or R345 on the same claim.
- Attempting to bill F019 (bone graft harvest) or Z279 (additional bone graft) in conjunction with these procedures; these are explicitly excluded by the Schedule of Benefits when E497 is claimed.
- Failing to document the specific pedicle and vascularity of the graft, which is required to justify the use of E497 over standard non-vascularized bone graft billing.
Billing Tips
- Ensure the primary procedure (R322 or R345) is billed as the main line item, with E497 listed as the secondary procedure to ensure proper processing of the add-on fee.
Provider Fee$526.40
Effective: April 1, 2025
Category
N. Musculoskeletal System Surgical Procedures
Subcategory
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Service Type
Procedure
Code Classes
Musculoskeletal System Surgical Procedures
R322 and R345 must include fixation and a non-vascularized bone graft.
E497 is payable in addition to R322 and R345 if a pedicled vascularized bone graft is used in addition to, or in place of a non-vascularized bone graft.
F019 and Z279 rendered in conjunction with R322 and R345 are not eligible for payment.
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