E677 – Transbronchial needle aspiration of mediastinal and/or hilar lymph nodes
OHIP Surgical Assists Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This service is payable in addition to the fee for flexible or rigid bronchoscopy (`Z327`). It specifically covers the act of performing a transbronchial needle aspiration (TBNA) to obtain samples from mediastinal and/or hilar lymph nodes. As an add-on procedure, its eligibility is dependent on the proper billing of the primary bronchoscopy. General surgical rules, such as those for multiple procedures and after-hours premiums, apply.
When to Use
- Use E677 when performing a needle aspiration of mediastinal or hilar lymph nodes during a flexible or rigid bronchoscopy (Z327) for diagnostic staging of lung cancer.
- Use E677 to bill for the specific procedural act of TBNA when tissue sampling is required beyond the standard visual inspection and bronchial washings provided under Z327.
Common Pitfalls
- Billing E677 without an accompanying Z327 claim will result in an automatic rejection, as it is strictly an add-on procedure.
- Attempting to bill E677 for lymph node biopsies performed via other surgical approaches (e.g., mediastinoscopy) is incorrect and constitutes a billing error.
- Failing to apply the 85% multiple procedure rule when E677 is performed alongside other surgical procedures during the same operative session.
Billing Tips
- Ensure E677 is submitted on the same claim as Z327 to maintain the required linkage for the add-on fee.
- If performing multiple procedures, remember that the major procedure is paid at 100% while E677, if considered the secondary procedure, is subject to the 85% payment adjustment rule.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Procedure
Respiratory Surgical Procedures
When bronchoscopy, flexible or rigid, is rendered in conjunction with laryngoscopy or oesophagoscopy, only the bronchoscopy is eligible for payment.
Bronchoscopy rendered by the same surgeon immediately following thoracic surgery under the same anaesthetic is not eligible for payment.
Bronchoscopy (including intraoperative bronchoscopy) rendered the same day as a major lung resection is not eligible for payment if a bronchoscopy has been rendered by the same physician to the same patient in the 3-week period preceding the major lung resection.
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