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E106
E106 – Penetrating wound with prolapse of intraocular tissue
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
This service is for the surgical repair of a penetrating wound to the eyeball that includes a prolapse of intraocular tissue. The fee for the surgeon is a flat rate, while fees for the assistant and anaesthetist are calculated based on base units plus time units. This procedure is found in the Ocular and Aural Surgical Procedures section of the Schedule. See .
When to Use
- Use E106 specifically for traumatic globe ruptures or penetrating injuries where uveal tissue, vitreous, or lens material has prolapsed through the wound site.
- Select E106 over E104 (repair of simple corneal/scleral wound) when the complexity of the injury necessitates the management of prolapsed intraocular contents.
Common Pitfalls
- Billing E106 in conjunction with a standard hospital admission assessment (A001) is a common audit trigger; ensure you only bill the major pre-operative visit if the decision to operate was made during that encounter.
- Attempting to bill for a second surgical assistant without prior authorization or a supporting letter will result in automatic rejection, as E106 is not on the pre-approved list for multiple assistants.
Billing Tips
- Ensure the operative report explicitly describes the prolapsed tissue, as this documentation is the primary defense against claims being downgraded to a simpler repair code like E104 or E105.
- If the procedure is performed after hours, ensure you append the appropriate after-hours procedure premium to maximize the claim, as E106 is eligible for these add-ons.
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