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E164
E164 – Drainage of abscess
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Drainage of an abscess of the orbit. This is a surgical procedure listed under the 'Ocular and Aural Surgical Procedures' section of the Schedule of Benefits. As a surgical service, payment includes the necessary pre-operative and post-operative care associated with the procedure. It is eligible for surgeon (suffix A) and anaesthetist (suffix C) fees. Assistant fees are not payable for this procedure.
When to Use
- Use E164 for the formal surgical incision and drainage of an orbital abscess requiring an operating room setting.
- Select this code when the procedure is performed as a distinct surgical intervention, rather than a simple office-based aspiration or minor lid procedure.
Common Pitfalls
- Do not bill E164 in conjunction with an assistant fee, as the Schedule of Benefits explicitly excludes assistant coverage for this procedure.
- Avoid billing E164 for minor office-based drainage of superficial eyelid abscesses, which may be more appropriately billed under minor surgical codes.
- Failure to document the specific orbital location and the surgical nature of the drainage can lead to audit scrutiny regarding the necessity of the surgical fee.
Billing Tips
- Ensure that all pre-operative and post-operative care is bundled into the E164 fee, as separate office visits for routine post-operative follow-up are not billable.
- If the procedure is performed on an emergency basis after hours, ensure the appropriate E409 or E410 premium is applied to the base fee to maximize reimbursement.
Provider Fee$620.70
Anaesthetist Fee$111.72
Non-Anaesthetist Fee$111.72
Effective: April 1, 2026
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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