E748 – Panniculectomy with repair of umbilical hernia
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on code for the repair of an umbilical hernia, intended to be billed in addition to S318 (Panniculectomy). The eligibility for this service is contingent upon the primary panniculectomy procedure meeting the insurance criteria outlined in Appendix D of the Schedule, which includes a requirement for prior authorization from the Ministry of Health (MOH).
When to Use
- Use E748 only when repairing a clinically significant umbilical hernia that is discovered and addressed during the course of an MOH-approved S318 panniculectomy.
- Use E748 as an add-on to S318 when the hernia repair is medically necessary and distinct from the cosmetic components of the panniculectomy.
Common Pitfalls
- Billing E748 without an approved prior authorization for the primary S318 procedure will result in an automatic rejection of both codes.
- Attempting to bill E748 for an umbilical hernia repair performed during an abdominoplasty will result in a claim rejection, as abdominoplasty is not an insured service.
- Submitting E748 without the S318 code on the same claim will cause a payment denial, as E748 is strictly an add-on service.
Billing Tips
- Ensure the operative report explicitly documents the presence and repair of the umbilical hernia to justify the E748 fee in addition to the S318 procedure.
- Verify that the S318 procedure meets the specific medical necessity criteria in Appendix D before scheduling, as E748 is entirely dependent on the primary code's eligibility.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Procedure
Digestive System Surgical Procedures
Panniculectomy is only insured in those circumstances described in Appendix D of this Schedule. Prior authorization of payment from the MOH is required.
S318 is not eligible for payment when performed in conjunction with abdominal or pelvic procedures unless the payment requirements for panniculectomy are separately fulfilled.
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