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E621
E621 – Diagnostic wedge resection
OHIP Surgical Assists Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
E621 is an add-on code payable in addition to the fee for a primary lung excision procedure when a diagnostic wedge resection is also performed. This service is listed under the Respiratory Surgical Procedures section for Lungs and Pleura.
When to Use
- Use E621 when performing a diagnostic wedge resection to obtain tissue for pathology during a primary lung excision procedure, such as a lobectomy or segmentectomy.
- Use E621 when a separate, distinct wedge resection is performed for diagnostic purposes on a different lobe or segment than the primary excision procedure.
Common Pitfalls
- Do not bill E621 for a wedge resection that is the primary therapeutic procedure; it is strictly an add-on code for diagnostic purposes performed alongside a major excision.
- Avoid billing E621 if the wedge resection is considered an integral part of the primary procedure's surgical approach or standard dissection, as this may be flagged as unbundling.
- Failure to apply the 85% payment rule for secondary procedures when multiple lung procedures are performed during the same operative session will lead to incorrect claim processing.
Billing Tips
- Ensure the primary lung excision procedure (e.g., lobectomy) is billed as the major procedure to capture the full fee, with E621 appended as the secondary procedure subject to the 85% rule.
- Clearly document the diagnostic intent of the wedge resection in the operative report to distinguish it from the therapeutic intent of the primary lung excision.
Provider Fee$45.85
Effective: April 1, 2025
Category
P. Respiratory Surgical Procedures
Subcategory
RESPIRATORY SURGICAL PROCEDURES
Service Type
Premium
Code Classes
Respiratory Surgical Procedures, Other Premiums (including After Hours Procedure Premiums)
The following E codes may apply to the preceding M prefix excision codes.
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