E540 – Excision for tumour free margin with frozen section
OHIP Surgical Assists Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This premium provides a 25% increase to the fee for an applicable primary procedure. It is payable when an excision is performed in a hospital to achieve tumour-free margins for a malignant lesion, and this is confirmed with a frozen section. It can be applied to excision, repair, flap, or graft procedures. According to page , it is payable once per lesion when added to the first flap or graft procedure. According to page , it can be added to excision or repair fees, such as for malignant melanoma (R010).
When to Use
- Use E540 when performing a primary excision of a malignant lesion (e.g., R010) where the surgical plan requires immediate intraoperative confirmation of clear margins via frozen section.
- Apply E540 to the primary procedure code when a subsequent flap or graft (e.g., R045-R049) is necessary to close the defect created by the margin-controlled excision.
Common Pitfalls
- Billing E540 for routine excisions where permanent pathology is awaited, as the premium strictly requires an intraoperative frozen section report.
- Attempting to claim E540 for multiple lesions in the same operative field; it is payable only once per lesion regardless of the number of tissue sections analyzed.
- Failing to link the premium to the primary procedure code, which often leads to automated rejections if the primary code does not support the percentage increase.
Billing Tips
- Ensure the pathology report explicitly references the frozen section results to satisfy audit requirements for the 25% premium.
- When combining with a repair, apply the 25% increase only to the primary excision or the first flap/graft code, not to the entire surgical tray.
Percentage Premium: 0.25%
This code applies a percentage increase to the base procedure fee
Effective: July 1, 2013
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
PercentageIncrease
Other Premiums (including After Hours Procedure Premiums), Integumentary System Surgical Procedures
The pathologist's report for the malignant lesion must be retained in the patient's record.
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