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E691
E691 – Omphalocele and gastroschisis - requiring mobilization of abdominal wall musculature
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on code to be claimed in addition to `S348` for the primary or first stage repair of omphalocele and gastroschisis. This code is applicable when the surgical repair requires mobilization of the abdominal wall musculature.
When to Use
- Use E691 when performing the primary repair of a gastroschisis where the defect size necessitates the surgical mobilization of the abdominal wall musculature to achieve closure.
- Use E691 for the first-stage repair of an omphalocele when the abdominal wall musculature must be mobilized to facilitate the reduction of the viscera and primary fascial closure.
Common Pitfalls
- Billing E691 as a standalone code; it is strictly an add-on and will be rejected if not submitted on the same claim as S348.
- Claiming E691 for simple primary closures that do not involve the specific mobilization of the abdominal wall musculature, which constitutes an audit risk for upcoding.
- Failing to document the specific surgical technique used to mobilize the musculature, which is required to justify the additional fee beyond the base S348 procedure.
Billing Tips
- Ensure E691 is linked to the S348 primary procedure code on your claim submission to avoid automatic rejection by the Ministry.
- Apply relevant age premiums (e.g., AGE_PREMIUM_UNDER_30_DAYS) to the total fee, as E691 is a surgical procedure code eligible for these percentage increases.
Provider Fee$178.40
Effective: April 1, 2025
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
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