E725 – Recurrent hernia repair
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This fee code represents an additional amount payable to the surgeon and assistant when performing a repair of a recurrent hernia. It is claimed in addition to the primary hernia repair code. This add-on applies to all types of hernia repair except for oesophageal hernia.
When to Use
- Use when performing a repeat repair of an inguinal, femoral, or ventral hernia at the same site where a previous surgical repair was performed.
- Use when the operative report explicitly confirms the presence of scar tissue or anatomical distortion consistent with a prior hernia repair at the same location.
Common Pitfalls
- Billing E725 for a primary hernia repair at a new site; it is strictly reserved for recurrent hernias at the site of a previous procedure.
- Attempting to claim E725 for an oesophageal hernia repair, which is explicitly excluded by the Schedule of Benefits.
- Failing to document the history of the previous hernia repair in the operative note, which is a common trigger for audit recovery.
Billing Tips
- Always link E725 to the primary hernia repair code (e.g., S322, S326) on the same claim to ensure the premium is processed correctly.
- Ensure the operative report clearly describes the findings of the recurrence, such as 'recurrent inguinal hernia' or 'prior mesh identified', to justify the additional complexity.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
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Digestive System Surgical Procedures
Standard medical record requirements for a surgical procedure apply. The record must document that the hernia being repaired is recurrent.
Payable as an add-on to the primary hernia repair fee for a recurrent hernia.
Does not apply to oesophageal hernia repair.
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