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E165
E165 – Lateral orbitotomy (Kronlein)
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
E165 is for performing a lateral orbitotomy, commonly known as a Kronlein procedure. This surgical intervention is used to gain exposure to the lateral aspect of the orbit, often for the removal of a tumour or foreign body. This code is for the surgeon's fee and can be billed with suffixes for assistant ('B') and anaesthetist ('C') services as detailed on page of the Schedule.
When to Use
- Use E165 for the surgical approach to the lateral orbit specifically to facilitate the removal of deep-seated orbital tumors or foreign bodies.
- Select E165 when the surgical plan necessitates a formal bone-resecting lateral orbitotomy (Kronlein) rather than a simple transconjunctival or transcutaneous biopsy.
Common Pitfalls
- Billing E165 in conjunction with other orbital exploration codes like E166 or E167 is often flagged as unbundling; ensure the procedure performed matches the specific bone-resection requirements of a Kronlein approach.
- Failure to document the specific surgical steps of the lateral orbitotomy, such as the lateral canthotomy and zygomatic bone resection, risks rejection during post-payment audits.
Billing Tips
- Ensure the claim includes the appropriate suffix 'B' for surgical assistants or 'C' for anaesthetists if these services were utilized, as these are distinct from the primary surgeon's fee.
- If the procedure is performed on an emergency basis after hours, verify the eligibility of E409 or E410, ensuring the start time is clearly documented to support the premium claim.
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