E109 – Enucleation/evisceration with insertion of implant and reattachment of extraocular muscles
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving the removal of the eye's contents (evisceration) or the entire eyeball (enucleation), followed by the placement of an orbital implant and the reattachment of the extraocular muscles to the implant. This procedure is typically performed to manage a blind, painful eye, a severely traumatized eye, or an intraocular tumor. The service includes fees for the surgeon (E109A), surgical assistant (E109B), and anaesthetist (E109C).
When to Use
- Use E109 when performing a formal enucleation or evisceration that specifically includes the placement of an orbital implant and the reattachment of extraocular muscles.
- Select E109 for the management of a blind, painful eye or a severely traumatized eye where the globe must be removed and replaced with an implant to maintain orbital volume.
Common Pitfalls
- Do not bill E102 or E103 in conjunction with E109, as these are explicitly restricted and will result in a claim rejection.
- Failure to document the specific surgical components—specifically the implant insertion and muscle reattachment—can lead to audit discrepancies if the claim is reviewed for the complexity implied by E109.
Billing Tips
- Ensure that if the patient is under 16 years of age, you apply the appropriate age-based fee premium to the E109A surgical fee to maximize the claim value.
- If the procedure is non-elective and performed after hours, verify that you are applying the correct E409 or E410 premium to the procedural fee, as these are mutually exclusive with other special visit premiums.
Effective: April 1, 2026
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures
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