E122 – Corneal transplant - lamellar
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
A lamellar corneal transplant is a surgical procedure for the replacement of a portion of the cornea. This service is designated as E122A for the surgeon and is eligible for an assistant fee (E122B) with 6 base units and an anaesthesia fee (E122C) with 7 base units. As a surgical procedure, it may be eligible for various premiums such as age-based increases for patients under 16 (), after-hours premiums (e.g., E409, E410), and the trauma premium (E420) if criteria are met.
When to Use
- Use E122A for lamellar keratoplasty procedures where only a partial thickness of the corneal stroma is replaced, distinguishing it from full-thickness penetrating keratoplasty (E121).
- Select this code when performing anterior lamellar procedures, such as Deep Anterior Lamellar Keratoplasty (DALK), to treat corneal ectasia or stromal scarring while preserving the patient's own endothelium.
Common Pitfalls
- Billing E122A alongside other ocular surgical procedures performed under the same anaesthetic requires careful adherence to the 'major procedure' rule, where only the highest base units apply for the assistant and anaesthetist.
- Attempting to claim after-hours premiums (E409/E410) concurrently with the trauma premium (E420) will result in a rejection, as these are mutually exclusive under OHIP rules.
- Failure to document the specific Injury Severity Score (ISS) on the claim submission when applying the E420 trauma premium will lead to automatic rejection.
Billing Tips
- Ensure the anaesthesia (E122C) and assistant (E122B) claims explicitly record start and end times in the patient chart, as these are mandatory for audit verification of time-based units.
- Always verify if the patient qualifies for age-based premiums (GP64) for surgical procedures in parts K to Z, as these are percentage-based increases that apply automatically to the E122A base fee.
Effective: April 1, 2025
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures
For anaesthesia and assistant services, the start and end times must be recorded in the patient's medical record for calculation of time units.
The medical record must establish that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary.
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