E186 – Intravitreal injection of medication for the treatment of wet macular degeneration, left eye
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
This service is for the intravitreal injection of medication for the treatment of wet macular degeneration, specifically for the left eye. It is classified as an ocular surgical procedure. Payment is subject to a limit of 12 services per patient per 12-month period, with exceptions requiring clinical justification. Assistant services are not payable. Anaesthesia services for E186 are associated with fee code E023C. Time units and anaesthesia extra units listed on are not eligible for payment with anaesthesia services for E186C. E003C is not payable for anaesthesia services rendered for E186. The add-on code E175 for therapeutic paracentesis may be claimed if performed via a separate site.
When to Use
- Use E186 specifically for the intravitreal injection of medication into the left eye for wet macular degeneration.
- Use E187 if the same procedure is performed on the right eye, as these are laterality-specific codes.
- Use E175 as an add-on code only when a therapeutic paracentesis is performed at a separate site from the E186 injection.
Common Pitfalls
- Claiming E175 when the paracentesis is performed through the same site as the E186 injection, which is strictly prohibited.
- Attempting to bill E003C for anaesthesia services, which is explicitly restricted for this procedure.
- Exceeding the 12-service limit per 12-month period without clear documentation of clinical necessity in the patient's permanent record, leading to potential audit recovery.
Billing Tips
- If you perform a therapeutic paracentesis, ensure your operative note clearly specifies that it was done via a separate site to justify the E175 add-on.
- When billing for anaesthesia support, use E023C and avoid adding time units or extra units from GP97, as these are ineligible for payment with E186.
Effective: April 1, 2025
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures
For services in excess of 12 per 12-month period, the physician must document the appropriate clinical indications on the patient's permanent medical record.
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