E862 – Laparoscopic premium for retropubic urethropexy
OHIP Surgical Assists Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
A 25% premium added to the surgical fee when specific urogenital and gynaecological procedures are performed laparoscopically. This premium applies to the surgeon's fee for the following services: - Retropubic Urethropexy for Stress Incontinence (from section on Urethra): - S549 - primary procedure - S546 - repeat procedure - Combined Abdominal-Vaginal Sling Procedures (from section on Vagina): - One surgeon: S728 (primary), S731 (after one failed procedure), S748 (after two or more failed procedures) - Two surgeons (abdominal surgeon's component): S740, S733, S751 - Hysterectomy (from section on Corpus Uteri): - S757 - abdominal total or subtotal - S816 - vaginal - S758 - with anterior and posterior vaginal repair - S759 - with anterior or posterior vaginal repair - S710 - with omentectomy for malignancy - S763 - radical (Wertheim or Schauta) - S762 - radical trachelectomy - Other Female Genital Procedures: - S760, S813, S761 (Colposuspension/Sacrocolpopexy)
When to Use
- Use E862 when performing a laparoscopic hysterectomy (e.g., S757) to capture the 25% premium for the minimally invasive approach.
- Apply this code when performing a laparoscopic colposuspension or sacrocolpopexy (S760, S761) to account for the increased technical complexity compared to open abdominal techniques.
- Use E862 for laparoscopic retropubic urethropexy (S549) to distinguish the procedure from the traditional open Burch procedure.
Common Pitfalls
- Do not bill E862 for robotic-assisted procedures unless specifically authorized, as it is strictly defined for laparoscopic techniques.
- Avoid billing E862 on procedures not explicitly listed in the Schedule of Benefits; it is not a blanket premium for all laparoscopic surgery.
- Ensure the primary surgical code (e.g., S757) is eligible for the premium; billing E862 with an incompatible or non-listed procedure will result in an automatic rejection.
Billing Tips
- Always link E862 directly to the primary surgical procedure code on the same claim to ensure the 25% calculation is applied correctly by the system.
- If performing a combined procedure where only one component is laparoscopic, ensure you are only applying the premium to the eligible laparoscopic service code.
Percentage Premium: 0.25%
This code applies a percentage increase to the base procedure fee
Effective: September 1, 2011
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
PercentageIncrease
Female Genital Surgical Procedures, Urogenital and Urinary Surgical Procedures, Other Premiums (including After Hours Procedure Premiums)
See also procedures for stress incontinence in Female Genital Surgical Procedures.
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