E809 – Excision of panniculus extending beyond mid thigh
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on fee payable to the surgeon in addition to `S318 (Panniculectomy), for the additional work of excising a pannus that extends beyond the mid-thigh. As it is billed with S318`, it is subject to the same payment requirements, including that the service is only insured in circumstances described in Appendix D of the Schedule and requires prior authorization from the MOH.
When to Use
- Use E809 only when the pannus physically extends beyond the mid-thigh level, necessitating additional surgical excision beyond the standard S318 procedure.
- Apply this code strictly in conjunction with S318 when the patient meets the specific medical necessity criteria outlined in Appendix D of the Schedule.
Common Pitfalls
- Billing E809 without obtaining prior authorization from the Ministry of Health specifically for the extended excision will result in automatic rejection.
- Attempting to bill E809 for cosmetic abdominoplasty or standard panniculectomy that does not reach the mid-thigh threshold constitutes an audit risk for inappropriate upcoding.
- Failing to document the specific extent of the pannus relative to the mid-thigh in the operative report makes the claim indefensible during a post-payment audit.
Billing Tips
- Ensure the prior authorization request explicitly details the anatomical extent of the pannus to justify the use of E809 alongside S318.
- Always link E809 to the same claim as S318 to ensure the add-on logic is processed correctly by the Ministry.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Procedure
Digestive System Surgical Procedures
In circumstances where the proposed panniculectomy surgery may include excision of a pannus that extends below the mid thigh, the requesting physician must provide sufficient information with the request for prior authorization of payment.
Panniculectomy is only insured in those circumstances described in Appendix D of this Schedule. Prior authorization of payment from the MOH is required.
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