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E511

E511Additional midtarsal(s) to R695

OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits

This service is for the arthrodesis (surgical fusion) of additional midtarsal joint(s) and is only payable as an add-on to R695 (Subtalar arthrodesis).

When to Use

  • Use E511 when performing an arthrodesis on a midtarsal joint in the same operative session as a subtalar arthrodesis (R695).
  • Use this code for each additional midtarsal joint fused beyond the primary subtalar procedure to accurately reflect the increased surgical complexity.

Common Pitfalls

  • Billing E511 as a standalone procedure without R695 will result in an automatic rejection.
  • Attempting to use E511 for joints outside of the midtarsal complex, such as metatarsophalangeal joints, is a common audit trigger for incorrect coding.
  • Failure to clearly document the specific midtarsal joints addressed in the operative report can lead to claim recovery during a post-payment audit.

Billing Tips

  • Ensure R695 is billed as the primary procedure code on the claim to establish the necessary foundation for the E511 add-on.
Provider Fee$175.80

Effective: April 1, 2026

Category

N. Musculoskeletal System Surgical Procedures

Subcategory

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES

Service Type

Procedure

Code Classes

Musculoskeletal System Surgical Procedures

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