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E516
E516 – Endocarditis complexity premium
OHIP Surgical Assists Code · Schedule of Benefits
Endocarditis complexity premium, to procedural fee(s)
When to Use
- Use E516 when performing a valve replacement (e.g., R724) specifically necessitated by active vegetation or annular abscess confirmed by preoperative imaging.
- Apply this premium during urgent surgical debridement or reconstruction of cardiac structures (e.g., R726) where active endocarditis significantly increases technical complexity compared to elective cases.
Common Pitfalls
- Billing E516 for patients with a history of endocarditis who are undergoing routine valve surgery for non-infectious reasons; the infection must be active.
- Attaching E516 to procedural codes that are not explicitly listed as eligible, leading to automatic rejection by the Ministry.
- Failing to clearly document the intraoperative findings of infection, which is the primary audit trigger for this premium.
Billing Tips
- Ensure E516 is submitted on the same claim as the primary cardiovascular procedure (e.g., R724-R737) to trigger the 25% automatic calculation.
Provider Fee$0.01
Effective: April 1, 2026
Service Type
Surgical Premium
Code Classes
Premium
Active infective endocarditis (IE) must be confirmed by preoperative diagnostics and operative findings.
The IE must directly impact the surgical procedure.
R724Cardiovascular surgical procedureR725Cardiovascular surgical procedureR772Cardiovascular surgical procedureR726Cardiovascular surgical procedureR727Cardiovascular surgical procedureR731Cardiovascular surgical procedureR728Cardiovascular surgical procedureR729Cardiovascular surgical procedureR730Cardiovascular surgical procedureR734Cardiovascular surgical procedureR735Cardiovascular surgical procedureR733Cardiovascular surgical procedureR773Cardiovascular surgical procedureR774Cardiovascular surgical procedureR930Cardiovascular surgical procedureR732Cardiovascular surgical procedureR736Cardiovascular surgical procedureR737Cardiovascular surgical procedureR863Cardiovascular surgical procedureR876Cardiovascular surgical procedure
E516 adds 25% to the procedural fee(s).
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