E685 – Total excision of very large sessile polyp (> 3 cm) through colonoscope
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Total excision of very large sessile polyp (> 3 cm) through colonoscope, and may include fulguration, each. The term 'each' indicates this fee is applicable for each individual large sessile polyp removed that meets the size criteria. This service is performed via colonoscopy. Fulguration is an included component of the service. As a surgical procedure, this service includes the common elements of all insured services (, ) and the specific elements of a surgical procedure ().
When to Use
- Use E685 for the complete endoscopic removal of a single sessile polyp measuring greater than 3 cm, which is distinct from the standard polypectomy code Z513.
- Apply this code when the procedure involves complex excision techniques such as endoscopic mucosal resection (EMR) for large sessile lesions that exceed the 3 cm threshold.
Common Pitfalls
- Billing E685 for multiple polyps that are each smaller than 3 cm; the size requirement is specific to each individual lesion excised.
- Failing to explicitly document the polyp size in the operative report, which is a mandatory requirement for audit compliance and claim validation.
- Attempting to bill E685 in conjunction with Z513 for the same lesion; E685 is intended for large sessile polyps and is not an add-on to standard polypectomy codes.
Billing Tips
- Since the code is defined as 'each', you may bill E685 multiple times if you excise more than one sessile polyp that individually meets the >3 cm size criteria.
- Ensure the operative note clearly describes the sessile morphology and the measured size to justify the use of this higher-value code over standard excision codes.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
The size of the excised polyp must be documented in the medical record to confirm it is greater than 3 cm.
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