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E160
E160 – Dermis fat graft - immediately following enucleation
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Dermis fat graft - immediately following enucleation is a reconstructive surgical procedure of the orbit. This procedure is performed in conjunction with an eye removal (enucleation) surgery to add volume to the socket.
When to Use
- Use E160 exclusively as an add-on to an enucleation procedure (e.g., E102 or E109) when a dermis fat graft is harvested and placed to provide volume to the anophthalmic socket.
- This code is appropriate when the graft is performed during the same operative session as the primary enucleation to address volume deficiency.
Common Pitfalls
- Billing E160 as a standalone procedure will result in an automatic rejection, as it is strictly defined as an add-on to an enucleation.
- Attempting to bill E160 for secondary socket reconstruction or revision procedures is incorrect; it is specifically for grafts performed 'immediately' at the time of the initial enucleation.
- Failure to link the E160 claim to the primary enucleation code on the same submission can lead to payment processing errors.
Billing Tips
- Ensure the primary enucleation code (E102 or E109) is submitted on the same claim to satisfy the 'immediately following' requirement for E160.
- Apply relevant age-based premiums (e.g., for patients under 16) to the E160 fee, as it is a surgical procedure listed in the applicable sections of the Schedule of Benefits.
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