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E849
E849 – Resection of diaphragm and reconstruction requiring repair with mesh or equivalent synthetic material
OHIP Surgical Assists Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Payable as an add-on to a primary lung or pleural excision procedure when the surgery also involves resection of the diaphragm and reconstruction requiring repair with mesh or equivalent synthetic material. This is added to the fee for the primary procedure. See page of the Schedule of Benefits under the 'Lungs and Pleura' section for a list of other related add-on codes.
When to Use
- Use E849 when performing a diaphragmatic resection and reconstruction with synthetic mesh as a mandatory adjunct to a primary lung or pleural excision procedure.
- Apply this code when the diaphragmatic involvement is a direct extension of the primary thoracic malignancy or pathology requiring en-bloc resection.
Common Pitfalls
- Billing E849 as a standalone procedure; it is strictly an add-on code and will be rejected if submitted without a primary lung or pleural excision code.
- Failing to document the specific use of synthetic mesh or equivalent material, which is a mandatory requirement for the validity of this code.
Billing Tips
- Ensure the primary procedure is billed at 100% and E849 is appended correctly to trigger the add-on payment logic.
- Verify that the reconstruction technique explicitly mentions the use of synthetic material in the operative report to satisfy audit requirements for the 'equivalent synthetic material' clause.
Provider Fee$220.00
Effective: April 1, 2025
Category
P. Respiratory Surgical Procedures
Subcategory
RESPIRATORY SURGICAL PROCEDURES
Service Type
Procedure
Code Classes
Respiratory Surgical Procedures, Other Premiums (including After Hours Procedure Premiums)
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