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E605
E605 – Excision of mediastinal tumour or cyst
OHIP Surgical Assists Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This code is an add-on to M111 (Thoracoplasty, one stage) and is payable 'for each additional rib (more than 3) to a maximum of 3 additional'.
When to Use
- Use E605 as an add-on code specifically when performing a thoracoplasty (M111) that requires the resection of more than three ribs.
- Apply this code for each additional rib resected beyond the initial three, up to a maximum of three additional units.
Common Pitfalls
- Billing E605 without a corresponding M111 claim will result in an automatic rejection as it is strictly an add-on procedure.
- Exceeding the maximum of three units for E605 will trigger a rejection or audit, as the Schedule of Benefits limits the add-on to three additional ribs only.
- Failing to apply the 85% multiple procedure rule if other non-related surgical procedures are performed during the same operative session.
Billing Tips
- Ensure the total number of ribs resected is clearly documented in the operative report to justify the number of E605 units claimed beyond the base M111 procedure.
- When claiming multiple units of E605, ensure they are submitted on the same claim as the primary M111 procedure to avoid processing errors.
Provider Fee$55.60
Specialist Fee$0.00
Surgical Assistant Fee$0.00
Anaesthetist Fee$0.00
Non-Anaesthetist Fee$0.00
Effective: April 1, 2025
Category
P. Respiratory Surgical Procedures
Subcategory
RESPIRATORY SURGICAL PROCEDURES
Service Type
Procedure
Code Classes
Respiratory Surgical Procedures
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