E618 – Decortication of remaining lobe(s) or major thoracic lysis of adhesions
OHIP Surgical Assists Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
An add-on code for the decortication of remaining lobe(s) or major thoracic lysis of adhesions, requiring at least 60 minutes of additional dedicated operative time, during lung surgery. This fee is added to the primary surgical procedure. The schedule notes that this code applies to the preceding M prefix excision codes under the Lungs and Pleura section. As a surgical service, it is subject to general surgical billing rules, including potential eligibility for after-hours (E409, E410), trauma (E420), and age-based premiums. Payment rules state that E618 is only eligible for payment when a minimum of 60 minutes is dedicated to decortication of remaining lobes and/or major thoracic lysis of adhesions, exclusive of time spent rendering any other service or procedure to the patient. Medical record requirements mandate that the physician must record on the patient’s permanent medical record the time when the decortication or lysis of adhesions started and ended; failure to do so renders the service ineligible for payment.
When to Use
- Use E618 when performing extensive decortication of remaining lobes following a primary lung resection (M-prefix codes) that requires at least 60 minutes of additional, dedicated operative time.
- Use E618 for major thoracic lysis of adhesions that is distinct from the primary procedure and necessitates a minimum of 60 minutes of dedicated surgical effort.
Common Pitfalls
- Failure to explicitly document the start and end times of the decortication or lysis in the operative report is the most common cause for claim rejection and audit recovery.
- Billing E618 when the lysis of adhesions is considered an integral part of the primary surgical approach (e.g., standard access) rather than a distinct, time-intensive procedure exceeding 60 minutes.
- Including time spent on the primary procedure (e.g., lobectomy or wedge resection) when calculating the 60-minute threshold for E618; the time must be exclusive to the add-on service.
Billing Tips
- Ensure the operative report contains a dedicated section or clear narrative statement specifying the exact start and end times for the decortication or lysis to satisfy the mandatory documentation requirement.
- When applicable, stack E618 with after-hours premiums (E409, E410) or trauma premiums (E420) on the same claim to maximize reimbursement for complex, non-elective thoracic surgeries.
Effective: April 1, 2026
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
The physician must record on the patient’s permanent medical record the time when the decortication or lysis of adhesions started and ended. If the patient’s permanent medical record does not include this required information, the service is not eligible for payment.
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