E785 – Multiple biopsies for surveillance of inflammatory bowel disease-associated colorectal cancer or dysplasia
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service is an add-on to be claimed in addition to colonoscopy fee codes Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499, or Z555. It is applicable when more than 34 biopsies are taken from different sites for the purpose of screening for malignant changes in a patient diagnosed with ulcerative colitis. The description specifies '> 34 sites', meaning 35 or more biopsies are required.
When to Use
- Use E785 when performing a high-definition surveillance colonoscopy for patients with long-standing ulcerative colitis requiring random mucosal sampling of at least 35 distinct sites.
- Claim this code when conducting chromoendoscopy-guided biopsies for dysplasia surveillance in patients with inflammatory bowel disease, provided the total biopsy count exceeds 34.
Common Pitfalls
- The most frequent rejection occurs when the total number of biopsy sites documented is 34 or fewer; the code strictly requires > 34 sites (minimum 35).
- Billing E785 concurrently with E717 is a common audit trigger and will result in a claim rejection, as E717 is explicitly restricted when E785 is claimed.
- Failure to clearly itemize the biopsy sites in the procedure report makes the claim vulnerable to recovery during a post-payment audit.
Billing Tips
- Ensure your endoscopy reporting software automatically tracks the number of biopsy jars or sites to confirm you have met the 35-site threshold before appending E785 to your colonoscopy fee (e.g., Z491).
- If you perform a therapeutic intervention like angiodysplasia coagulation, you must choose between E717 and E785, as they cannot be billed together on the same encounter.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Procedure
Digestive System Surgical Procedures, Diagnostic and Therapeutic Procedures
The medical record must document that more than 34 biopsy sites were sampled.
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