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E551
E551 – Bone/fascial/dermis grafts - separate incision
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This code is an add-on payment applied when an autogenous bone, fascial, or dermis graft is harvested. To be eligible, the graft must be obtained from a donor site that requires its own separate incision, distinct from the primary surgical incision. It is billed in addition to the fee for the main surgical procedure.
When to Use
- Use E551 when harvesting an autogenous iliac crest bone graft through a separate incision during a spinal fusion or orthopedic reconstruction procedure.
- Apply this code when harvesting a fascia lata graft from the thigh for use in reconstructive procedures where the harvest site is distinct from the primary surgical site.
- Use E551 when harvesting a full-thickness dermis graft from a separate donor site to augment a primary surgical repair.
Common Pitfalls
- Do not bill E551 if the graft is harvested through the same incision as the primary procedure, as the 'separate incision' requirement is mandatory for payment.
- Avoid billing E551 for synthetic or allograft materials, as this code is strictly reserved for autogenous grafts requiring a donor site harvest.
- Do not bill E551 in conjunction with E552, as E552 is intended for different graft types or specific anatomical harvesting conditions that are mutually exclusive.
Billing Tips
- Ensure the operative report explicitly describes the separate incision and the specific anatomical site used for the graft harvest to support the claim during an audit.
- Always link E551 to the primary surgical procedure code on the same claim to ensure the add-on logic is correctly processed by the Ministry.
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