E176 – Fornix reconstruction
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Fornix reconstruction is a surgical procedure performed on the orbit to restore or create the pocket between the eyelid and the eyeball.
When to Use
- Use E176 for the surgical creation or restoration of the conjunctival fornix, typically following symblepharon lysis or severe scarring.
- Select E176 when performing fornix reconstruction as a distinct procedure, rather than as an incidental component of a more comprehensive orbital or eyelid reconstruction.
Common Pitfalls
- Billing E176 in conjunction with other eyelid or orbital procedures without ensuring the documentation clearly supports the distinct nature of the fornix reconstruction to avoid 'unbundling' audits.
- Failing to document the specific technique used for the reconstruction, which is necessary to differentiate E176 from other ocular codes like E177 or E178.
Billing Tips
- If E176 is performed bilaterally during the same operative session, ensure the claim is submitted with the appropriate bilateral indicator to receive the correct payment adjustment.
Effective: April 1, 2025
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
For payment of the E420 trauma premium, the Injury Severity Score (ISS) must be listed in the medical record.
For payment of anaesthesia extra units for high BMI (E010C), the patient's BMI > 40 must be documented.
For payment of anaesthesia extra units for ASA status (E022C, E017C, E016C), the ASA level determined at the pre-operative assessment must be documented.
For payment of the anaesthesia extra unit for unanticipated massive transfusion (E025C), the volume of red blood cells transfused must be documented.
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