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E127
E127 – Sclerotomy, posterior
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Sclerotomy, posterior, is a surgical procedure performed on the sclera. This service includes all common and constituent elements of an insured service as defined in the General Preamble (-, , ). As a surgical procedure, it includes pre-operative and post-operative care components.
When to Use
- Use E127 for a standalone posterior sclerotomy procedure, such as for the drainage of a suprachoroidal hemorrhage.
- Use this code when performing a posterior sclerotomy as a distinct surgical intervention that is not part of a more comprehensive procedure like a vitrectomy.
Common Pitfalls
- Do not bill E127 in conjunction with E152 or E153, as these are explicitly restricted and will result in a claim rejection.
- Attempting to bill for an assistant's service (suffix B) with E127 is ineligible for payment and will be rejected by OHIP.
- Ensure the procedure is not being billed as a component of a larger ocular surgery where the sclerotomy is considered an inherent part of the primary procedure's surgical approach.
Billing Tips
- If the patient meets the specific age criteria, ensure the appropriate age-based fee premium is applied to maximize the claim value.
- If the procedure is performed on an emergency, non-elective basis after hours, ensure you apply the correct E409 or E410 premium to the procedural fee.
Provider Fee$166.45
Anaesthetist Fee$61.96
Non-Anaesthetist Fee$61.96
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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