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E638
E638 – Transbronchial lung biopsy
OHIP Surgical Assists Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
E638A is payable in addition to `Z327A` (flexible or rigid bronchoscopy) when a transbronchial lung biopsy is performed. The procedure may be performed with or without image intensification. This service is subject to the general rules for surgical procedures outlined in the Surgical Preamble (-) and the specific rules for Bronchoscopy outlined in the Respiratory Surgical Procedures preamble ().
When to Use
- Use E638A as an add-on code specifically when performing a transbronchial lung biopsy during a flexible or rigid bronchoscopy (Z327A).
- Apply this code when obtaining tissue samples from the lung parenchyma via the bronchoscope, regardless of whether image intensification (fluoroscopy) is utilized.
Common Pitfalls
- Billing E638A as a standalone procedure; it is strictly an add-on code and will be rejected if the parent code Z327A is missing from the claim.
- Attempting to bill E638A alongside Z360A (emergency rigid bronchoscopy for airway obstruction), which is explicitly prohibited by the Respiratory Surgical Procedures preamble.
- Failing to account for the 3-week rule: E638A and its parent Z327A are ineligible if you performed a bronchoscopy on the same patient within the preceding 21 days and are also performing a major lung resection on the same day.
Billing Tips
- Ensure the claim includes the appropriate age-based surgical premium if the patient is under 16, as E638A is eligible for these percentage increases.
- If the procedure is performed after hours or during nights, apply the relevant E409 or E410 premiums to the base fee to maximize the procedural reimbursement.
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