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E694
E694 – Laparotomy with nephrectomy
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on code intended to be billed in conjunction with `S321A` for a laparotomy for acute trauma. It is applicable when a nephrectomy is also performed during the same surgical procedure.
When to Use
- Use E694 as an add-on to S321A when a nephrectomy is performed during a laparotomy specifically for acute trauma.
- Use this code to capture the additional complexity of a renal excision when the primary procedure is the exploratory laparotomy for trauma.
Common Pitfalls
- Billing E694 without S321A will result in an automatic rejection, as it is strictly an add-on code.
- Attempting to bill E694 for elective nephrectomies or non-trauma related procedures is an audit risk, as it is specifically designated for acute trauma cases.
- Failing to document the specific trauma indication and the nephrectomy procedure in the operative report will lead to recovery of funds during a post-payment audit.
Billing Tips
- Ensure the trauma premium (E420) is applied to the claim if the patient meets the ISS criteria, as E694 is part of the surgical procedure package eligible for this premium.
- When billing for the surgical assistant, ensure the assistant's fee is calculated based on the combined complexity of S321A and E694 to reflect the total operative time.
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