E640 – Chest wall reconstruction after resection
OHIP Surgical Assists Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Chest wall reconstruction performed after a chest wall resection where a significant defect of at least 5 cm in diameter remains, necessitating repair with synthetic material. This procedure is typically performed in conjunction with a primary chest wall resection (e.g., M105). As a surgical service, the fee includes pre-operative and post-operative care as detailed in the Surgical Preamble (:529).
When to Use
- Use E640 when a chest wall resection (e.g., M105) results in a defect of at least 5 cm in diameter that requires the application of synthetic mesh or prosthetic material for structural stability.
- Apply E640 as a secondary procedure code when the reconstruction is a distinct, necessary step following the primary resection of a chest wall tumor or infected tissue.
Common Pitfalls
- Billing E640 without explicit documentation of the defect size (minimum 5 cm) and the specific type of synthetic material used, which triggers automatic audit flags.
- Attempting to bill E640 as a standalone procedure; it is intended as an add-on to a primary resection and will be rejected if the primary surgical code is missing or does not support the reconstruction.
- Failing to apply the 85% payment adjustment rule (SP3:531) when E640 is performed alongside other major surgical procedures during the same anesthesia session.
Billing Tips
- Ensure the operative report clearly describes the dimensions of the chest wall defect and the fixation method of the synthetic material to satisfy the P12 documentation requirement.
- If performing a sternal resection in the same session, ensure E602 is billed alongside E640 to capture the full scope of the complex reconstruction.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
The significant defect (minimum 5 cm in diameter) and the use of synthetic material for repair must be documented in the patient's permanent medical record.
This is an add-on to a primary chest wall resection procedure.
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