E676A – Morbidly obese patient - major surgery
OHIP Surgical Assists Code — SURGICAL PREAMBLE · Schedule of Benefits
E676 is eligible for payment once per patient per physician in addition to the amount eligible for payment for the major surgical procedure(s) where a morbidly obese patient undergoes major surgery to the neck, thorax, peritoneal cavity, retroperitoneum, pelvis, or hip and: a. the patient has a Body Mass Index (BMI) greater than 40 for major surgery on the thorax, peritoneal cavity, retroperitoneum, pelvis, or hip, or a BMI greater than 45 for major surgery on the neck; b. the surgery is rendered under general anaesthesia using either an open technique for the neck, thorax, or hip, or an open or laparoscopic technique for the peritoneal cavity, pelvis, retroperitoneum; and c. the principal surgical technique is neither aspiration, core or fine needle biopsy, dilation, endoscopy, mediastinoscopy, thoracoscopy, cautery, ablation nor catheterization.
When to Use
- Use E676A for open abdominal procedures like a bowel resection or hysterectomy where the patient's BMI exceeds 40.
- Use E676A for open hip surgery or major thoracic procedures when the patient meets the BMI threshold of 40 and general anesthesia is utilized.
- Use E676A for open neck surgeries only when the patient's BMI is documented as greater than 45.
Common Pitfalls
- Billing E676A for laparoscopic procedures outside of the peritoneal, pelvic, or retroperitoneal cavities will result in rejection.
- Claiming the premium for minor procedures like biopsies, endoscopies, or ablations is a common audit trigger as these are explicitly excluded by the preamble.
- Failure to document the specific BMI value in the operative note often leads to recovery of funds during a Ministry audit.
Billing Tips
- Ensure the primary surgical procedure code is one of the eligible major surgeries defined in the surgical preamble to avoid automatic rejection.
- Always confirm the anesthesia record specifies 'general anesthesia' as E676A is strictly ineligible for cases performed under local or regional blocks.
Percentage Premium: 0.25%
This code applies a percentage increase to the base procedure fee
Effective: April 1, 2025
SP. Surgical Preamble
SURGICAL PREAMBLE
PercentageIncrease
Other Premiums (including After Hours Procedure Premiums)
E676 is only eligible for payment when the BMI is recorded in the patient's permanent medical record.
E676A/B is only payable with the procedures listed in the applicableToCodes field.
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