E764 – Umbilical hernia repair - add-on
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
An add-on fee for the repair of an umbilical hernia when performed at the same time as other abdominal surgery. This fee is added to the claim for the primary surgical procedure. Payment is conditional on the umbilical hernia being a pre-existing condition that was documented in the patient's permanent medical record prior to the date of the surgery.
When to Use
- Use E764 when performing an incidental umbilical hernia repair during a primary abdominal procedure, such as an elective cholecystectomy or bowel resection.
- Use this code when the patient has a documented, pre-existing umbilical hernia that is addressed while the abdomen is already open for a different primary surgical indication.
Common Pitfalls
- Claiming E764 for a hernia repair that was not documented in the patient's record as a pre-existing condition prior to the date of surgery will lead to audit recovery.
- Attempting to bill E764 as a standalone procedure is incorrect; it is strictly an add-on code and must be submitted on the same claim as the primary abdominal surgical fee.
Billing Tips
- Ensure the primary abdominal procedure code is listed first on the claim, followed by E764, to correctly trigger the add-on payment logic.
- Verify that the operative report explicitly notes the pre-existing nature of the hernia to satisfy the documentation requirement for this specific add-on fee.
Effective: April 1, 2026
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Procedure
Digestive System Surgical Procedures
Documentation in the patient's permanent medical record of a pre-existing umbilical hernia prior to the service being provided.
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