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E811
E811 – Recurrent fistulae repair premium
OHIP Surgical Assists Code · Schedule of Benefits
A percentage-based premium for the repair of recurrent fistulae, payable in addition to specific rectal excision procedures.
When to Use
- Use E811A when performing a definitive S250A repair on a fistula that has previously failed a prior surgical attempt.
- Apply E811A to S251A when performing a repeat exploration or Seton placement for a fistula that has recurred after a prior intervention.
Common Pitfalls
- Billing E811A for a primary fistula repair, which is a common audit trigger as the code is strictly reserved for recurrent cases.
- Failing to append the 'A' suffix to both the primary procedure code and the E811 premium, which will result in an automatic rejection.
Billing Tips
- Ensure the operative report explicitly states the history of the prior fistula repair to substantiate the 'recurrent' status required for the 25% premium.
Provider Fee$0.01
Effective: April 1, 2026
Service Type
Surgery
Code Classes
Premium
The clinical condition must be a recurrent fistula (a fistula that has returned after a previous repair).
E811 is listed specifically under the 'Rectum - Excision' subsection of the Digestive System Surgical Procedures section.
The premium does not apply to assistant (suffix B) or anaesthesia (suffix C) fees as no units are listed for these suffixes on page .
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