E192 – Ptosis
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Ptosis repair is a surgical procedure to correct a drooping upper eyelid. It is designated with a '#' prefix, indicating that when performed in a hospital, the facility costs (premises, equipment, supplies, and personnel) are funded by the hospital's global budget, as outlined in . The service fee includes payment for the surgeon, and separate calculations apply for assistant and anaesthetist services based on basic and time units.
When to Use
- Use E192 for the surgical correction of ptosis when the procedure involves standard levator advancement or resection techniques.
- Use E192 when the ptosis repair is performed as a standalone procedure or in conjunction with other non-graft ocular surgeries, provided the specific repair does not require a skin graft.
- Use E192 for patients where the drooping eyelid is primarily due to levator muscle dehiscence or involutional changes, distinguishing it from procedures requiring complex integumentary reconstruction.
Common Pitfalls
- Do not bill E192 if a skin graft is utilized; such cases must be billed under the Plastic Surgery Integumentary System section as per the code notes.
- Avoid billing E192 alongside E193 (which typically covers more complex or secondary ptosis repairs) unless distinct clinical criteria for both are met, as this may trigger a duplicate service audit.
- Failure to document the specific surgical technique (e.g., levator advancement) can lead to claims being flagged, as the Ministry may look for evidence that the procedure performed aligns with the E192 fee schedule.
Billing Tips
- Ensure that the '#' prefix is respected for hospital-based procedures, meaning you should not attempt to bill for facility or tray fees, as these are covered under the hospital's global budget.
- If the procedure is performed on a patient under 16 years of age, verify the correct age-based premium is applied to the surgeon's fee to maximize the claim value.
Effective: April 1, 2026
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures
With skin graft - see Plastic Surgery Procedures - Integumentary System.
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