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E126
E126 – Laser retinopexy for Retinopathy of Prematurity or retinoblastoma – both eyes
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Laser retinopexy for Retinopathy of Prematurity – both eyes.
When to Use
- Use E126 when performing bilateral laser retinopexy specifically for the treatment of Retinopathy of Prematurity (ROP) in both eyes during a single operative session.
- Use E126 for bilateral laser treatment of retinoblastoma, ensuring the diagnosis is clearly documented to support the procedure code.
Common Pitfalls
- Do not bill E126 in conjunction with E125, as E126 covers both eyes and billing both will result in a rejection for duplicate or overlapping services.
- Avoid billing E126 if the procedure is unilateral; E125 is the appropriate code for a single eye, and billing E126 for one eye is an audit risk for overbilling.
- Failure to provide the required clinical documentation for retinoblastoma or ROP can lead to claim rejection, as these are specific conditions mandated by the Schedule of Benefits.
Billing Tips
- Ensure the anaesthesia units are calculated based on the 6 basic units assigned to E126 when multiple procedures are performed under the same anaesthetic.
- If an assistant is required, you must submit a letter to the Ministry for authorization and use code M400B for the assistant's claim.
Provider Fee$1,245.00
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Category
Y. Ocular and Aural Surgical Procedures
Subcategory
OCULAR SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Ocular and Aural Surgical Procedures
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