E838 – Bronchoscopy in a high risk patient with respiratory failure
OHIP Surgical Assists Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This service is an add-on to bronchoscopy (`Z327`) and is for performing the procedure in a high-risk patient with respiratory failure, defined as severe hypoxemia or hypercapnia. Note: E838 is not eligible for payment unless the physician remains with the patient after the procedure is completed and until oxygen levels have returned to their pre-intervention level and it is apparent the patient will not require assisted ventilation. As this service is designated with a '#', when performed in a hospital, the premises, equipment, supplies, and personnel are funded by the hospital's global budget (:).
When to Use
- Use E838 as an add-on to Z327 when performing bronchoscopy on patients with severe hypoxemia or hypercapnia who require continuous physician monitoring post-procedure.
- Apply this code specifically when the patient's clinical status necessitates the physician's presence until oxygen saturation stabilizes to pre-intervention levels and the need for mechanical ventilation is ruled out.
Common Pitfalls
- Billing E838 without explicit documentation confirming the physician remained at the bedside until the patient's oxygen levels returned to pre-procedural baselines.
- Attempting to claim E838 for routine bronchoscopy cases that do not meet the specific threshold of respiratory failure or high-risk status defined in the Schedule of Benefits.
Billing Tips
- Ensure the medical record explicitly states the patient's pre-intervention oxygen levels and the time the physician was released from the bedside, as this is the primary audit trigger for this code.
- Remember that E838 is an add-on to Z327; ensure both codes are submitted on the same claim to avoid automatic rejection.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Procedure
Respiratory Surgical Procedures, Other Premiums (including After Hours Procedure Premiums)
E838 is not eligible for payment unless the physician remains with the patient after the procedure is completed and until oxygen levels have returned to their pre-intervention level and it is apparent the patient will not require assisted ventilation.
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