Education and Prevention Committee Billing Briefs

Education and Prevention Committee (EPC) Billing Briefs are prepared jointly by the Ministry of Health (MOH) and the Ontario Medical Association (OMA) to provide general advice and guidance to physicians on billing matters.

Category: Surgical Specialists 
Date of publication: May 27, 2025

Claims Tips: E550 is only eligible for payment for insertion of a closed irrigation related to the musculoskeletal system and does not apply to the application of vacuum dressing or bladder irrigation systems.

Fee code E550

  • E550 is listed in the Musculoskeletal System Surgical Procedures section of the Schedule under Wound Care.
  • This fee code is payable for insertion (implantation) of a closed irrigation system including inflow and outflow tubes during a surgical procedure for post-operative management related to the musculoskeletal system.
  • Note that application of any type of topical negative pressure wound dressing system, with or without automated topical wound solution instillation and removal, is not eligible for payment as E550.

Common claims concerns

  • Claiming E550 for surgical work other than the insertion of a closed irrigation system during a surgical procedure for post-operative management of musculoskeletal system pathology. This might include one-time irrigation of a surgical wound and/or insertion of a drainage tube without continuous irrigation and/or application of topical negative pressure wound therapy (“VAC”) system as the surgical dressing.
  • Claiming E550 for insertion of a continuous bladder irrigation system.
  • Claiming E550 for irrigation and/or dressing of laceration or for laceration suture/repair.

Examples

Example 1 – E550 eligible for payment

Dr. Bohn performs a knee arthroscopy on an 18-year-old male patient because of an acute septic knee joint.

Following arthroscopic debridement, synovectomy and thorough irrigation, Dr. Bohn establishes a closed irrigation system with inflow and outflow drainage tubes placed appropriately within the knee joint.

What fee code(s) are eligible for payment to Dr. Bohn?

Explanation:

  • The following fee codes are eligible for payment:
    • R699A for knee arthroscopy set up, non-degenerative disorders of the knee,
    • E492A for synovectomy, and
    • E550A for insertion of a closed irrigation system during a surgical procedure for post-operative management.

Example 2 – E550 not eligible for payment

Dr. Bohn performs sequestrectomy of a chronic tibial bone infection resulting from an open fracture.

Following irrigation and debridement, Dr. Bohn applies a topical negative pressure wound dressing, also known as a “VAC” dressing.

What fee code(s) are eligible for payment to Dr. Bohn?

Explanation:

  • R239A is eligible for payment for tibial sequestrectomy.
  • Note that R239A includes all associated soft tissue debridement as well as any soft tissue or bone biopsies sent at the time of sequestrectomy.
  • E550A is not eligible for payment for application of a VAC dressing or other topical negative pressure wound dressing devices.

Example 3 – E550 not eligible for payment

Dr. Curie performs transurethral resection for bladder cancer (multiple tumours).

Following cystoscopy and tumour removal, Dr. Curie inserts a three-way Foley catheter and initiates continuous bladder irrigation.

What fee code(s) are eligible for payment to Dr. Curie?

Explanation:

  • The following fee codes are eligible for payment:
    • Z634A for cystoscopy, excision of multiple tumours including base and adjacent muscles and electrocoagulation.
    • Note that fee codes Z632, Z633 and Z634 include cystoscopy when done at the same time as excision of tumour(s), therefore no additional cystoscopy fee code(s) are eligible for payment.
  • E550A is not eligible for payment for bladder irrigation or for irrigation systems associated with non-musculoskeletal procedures.

Keywords/tags

OHIP Claims; OHIP Payment; Musculoskeletal; Irrigation; Dressings; Vacuum; Infection

Contact information

For additional information, please visit the Resources for Physicians and the How to Get Help with Billing Questions pages on the ministry website.

If you have any billing or claims submission inquiries, please contact the Inquiry Services, Service Support Contact Centre (SSCC) by email or by calling 1-800-262-6524.

To provide feedback on EPC Billing Briefs, or to suggest topics for future EPC Billing Briefs, send an email to the attention of the joint MOH/OMA Education and Prevention Committee.

The Ministry of Health (MOH) and the Ontario Medical Association (OMA) have jointly prepared this educational resource to provide general advice and guidance to physicians on specific billing matters.

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Note: This document is technical in nature and is available in English only due to its limited targeted audience. This publication has been exempted from translation under the French Language Services Act. For questions or support regarding this document, please contact the Service Support Contact Centre (SSCC) by email or by calling 1-800-262-6524.

Remarque : Ce document est de nature technique et est disponible en anglais uniquement en raison de son public cible limité. Ce document a été exempté de la traduction en vertu de la Loi sur les services en français. Pour toute question ou de l’aide concernant ce document, veuillez contacter Les Services de renseignements, Centre de contact pour le soutien des services par courriel ou en téléphonant le 1-800-262-6524.