E077 – Identification of patient for a major eye examination
OHIP Surgical Assists Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Identification of patient for a major eye examination, is the service of determining that a patient aged 20 to 64 inclusive has a medical condition (other than diabetes mellitus, glaucoma, cataract, retinal disease, amblyopia, visual field defects, corneal disease, strabismus, recurrent uveitis or optic pathway disease) requiring a major eye examination and providing such a patient with a completed requisition.
When to Use
- Use E077 when a patient aged 20-64 presents with a systemic condition like thyroid eye disease or hydroxychloroquine therapy that necessitates a major eye exam, as these are not excluded conditions.
- Use E077 when documenting a medical necessity for an eye exam due to neuro-ophthalmological concerns that do not fall under the restricted list of ocular diseases.
Common Pitfalls
- Billing E077 for patients with excluded conditions like diabetes or glaucoma will result in automatic rejection or recovery during audit.
- Submitting E077 more than once per fiscal year for the same patient is a hard limit and will be rejected by the Ministry.
- Failing to provide the patient with a physical or electronic requisition form is a non-compliance issue that invalidates the claim.
Billing Tips
- Always bill E077 in conjunction with an A007 or equivalent office visit code to capture the assessment time, as E077 is a premium for the requisition service only.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Premium
Other Premiums (including After Hours Procedure Premiums)
A completed requisition must be provided to the patient.
For patients aged 20 to 64 inclusive
1. This service is limited to a maximum of one every four fiscal years by the same physician for the same patient unless the patient seeks a major eye examination from a physician other than the one to whom the original requisition was provided.
2. This service is limited to a maximum of one per fiscal year by any physician to the same patient.
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