L866 – Surgical Pathology, Level 6
OHIP Dermatology Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Represents the professional service for the examination and diagnosis of a Level 6 surgical pathology specimen. This service includes the gross description, dissection, processing, microscopic examination, interpretation, diagnosis, and generation of a formal pathology report for a highly complex specimen, such as a total organ resection (e.g., laryngectomy, pneumonectomy, esophagectomy, total gastrectomy, total colectomy, hepatectomy, pancreatectomy, nephrectomy, cystectomy, hysterectomy with adnexa) for a tumor.
When to Use
- Use L866 for the examination of major organ resections performed for malignancy, such as a total pneumonectomy, total gastrectomy, or radical nephrectomy.
- Select L866 when the specimen complexity exceeds the criteria for L865, specifically involving extensive dissection and microscopic evaluation of a total organ resection.
Common Pitfalls
- Billing L866 in conjunction with L861 through L865 or L867 for the same specimen will result in an automatic rejection due to mutually exclusive billing rules.
- Submitting L866 for specimens that do not meet the 'total organ resection' complexity threshold often leads to audit recovery; ensure the pathology report clearly justifies the Level 6 classification.
Billing Tips
- Ensure the pathology report explicitly documents the gross and microscopic findings that necessitate Level 6 complexity to withstand potential post-payment audits.
Effective: April 1, 2026
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Laboratory
Diagnostic and Therapeutic Procedures
All insured services must be documented in appropriate records. The record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary. For pathology, this includes the full pathology report with gross and microscopic findings, and final diagnosis.
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