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E704
E704 – Choledochoscopy
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on fee payable for performing a choledochoscopy during a primary biliary tract procedure. It must be claimed in addition to one of the following procedures: `S276 (Choledochotomy), S280 (Transduodenal sphincterotomy and choledochotomy), S281 (Choledochoduodenostomy or choledochoenterostomy or choledochocholechostomy), or S287` (Cholecystectomy) when also billed with E721 (with choledochotomy).
When to Use
- Use E704 when performing intraoperative choledochoscopy to inspect the biliary tree for residual stones or pathology during a formal choledochotomy (S276 or S280).
- Use E704 when performing choledochoscopy during a choledochoenterostomy (S281) to ensure the patency of the anastomosis or to clear the duct.
- Use E704 when performing a cholecystectomy (S287) that requires an open choledochotomy (E721) to explore the common bile duct.
Common Pitfalls
- Claiming E704 as a standalone procedure; it is strictly an add-on and will be rejected if not linked to an eligible primary procedure code (S276, S280, S281, or S287 with E721).
- Failing to include E721 when billing E704 with S287, as the Ministry requires the specific choledochotomy component to be present for the add-on to be valid.
- Attempting to bill E704 for diagnostic imaging or non-surgical endoscopy; it is specifically intended for surgical biliary tract exploration.
Billing Tips
- Ensure the primary procedure (e.g., S276) and the add-on (E704) are submitted on the same claim to avoid automatic rejection for missing base procedure.
- Verify that the operative report explicitly documents the use of the choledochoscope, as this is a common target for post-payment audits.
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