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E518
E518 – Each additional polyp (20 mm to 29 mm)
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on service for the excision of each additional polyp measuring between 20 mm and 29 mm, performed via colonoscopy. This code is intended to be used in conjunction with a primary polyp excision code, typically Z516. A maximum of two additional polyp excisions, from any combination of E720, E520, E519, or E518, can be claimed per patient, per day.
When to Use
- Use this code when you have already claimed a primary polyp excision code (e.g., Z516) for the largest polyp and are now billing for a second or third polyp that measures between 20 mm and 29 mm.
- Use this as an add-on when you perform multiple excisions during the same colonoscopy, provided the total count of additional polyp codes (E720, E520, E519, E518) does not exceed two per patient per day.
Common Pitfalls
- Claiming more than two additional polyp codes in total across the E720, E520, E519, and E518 series will result in automatic rejection of the excess claims.
- Failing to identify the largest polyp as the primary code (Z516, Z517, Z518, or Z571) before applying E518 as an add-on will lead to incorrect billing and potential audit flags.
- Attempting to bill for polyps smaller than 3 mm is prohibited; these are considered part of the base colonoscopy procedure and are not eligible for additional excision fees.
Billing Tips
- Always sequence your claims by identifying the largest polyp first to establish the primary code, then append the appropriate add-on codes for the remaining polyps based on their specific size brackets.
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