E847A – Diaphragm reconstruction with mesh
OHIP Surgical Assists Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This service is for the reconstruction of the diaphragm requiring repair with mesh or equivalent synthetic material. It is payable as an add-on to the following procedures:
- M105: Chest wall tumour, resection of 2 or 3 ribs or cartilages
- M106: Mediastinal tumour
- `S079: Massive paraesophageal hernia repair
- S089: Partial oesophageal resection and reconstruction
- S090: Total thoracic oesophageal resection
- S091: Oesophageal hiatus hernia repair, abdominal or transthoracic approach
- S092`: Recurrent oesophageal hiatus hernia repair
When to Use
- Use E847 when performing a mesh reinforcement of the crural repair during a standard S091 hiatus hernia repair.
- Apply E847 when resecting a mediastinal tumour (M106) that necessitates a patch repair of the diaphragm using synthetic mesh.
- Bill E847 when managing a massive paraesophageal hernia (S079) where the defect size requires mesh to prevent recurrence.
Common Pitfalls
- Billing E847 for primary suture repair of the diaphragm without the use of mesh or equivalent synthetic material will result in a rejection or audit recovery.
- Attempting to bill E847 as a standalone procedure will cause an automatic rejection, as it is strictly an add-on code requiring a primary procedure from the approved list.
- Failing to document the specific type of mesh used in the operative report is a common cause for audit failure regarding the necessity of this code.
Billing Tips
- Ensure E847 is submitted on the same claim as the primary procedure (e.g., S091 or M106) to avoid processing errors.
- Because E847 is exempt from the multiple surgical procedure reduction rule, ensure your billing software does not incorrectly apply the 85% reduction to this fee.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Procedure
Respiratory Surgical Procedures, Digestive System Surgical Procedures
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