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E196
E196 – Entropion, other than Zeigler puncture
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Surgical repair for entropion, a condition where the eyelid turns inward, using a method other than Zeigler puncture. This service is designated with a '#' prefix, indicating that when performed in a hospital, the costs for premises, equipment, supplies, and personnel are covered by the hospital's budget and not billed separately. Additional procedures may be billed, such as E945 for a repeat repair by a second surgeon, or E948 if a mucous membrane graft is required.
When to Use
- Use E196 for standard surgical correction of involutional or cicatricial entropion where a more complex reconstruction than a simple Zeigler puncture is required.
- Select E196 when performing a full-thickness eyelid rotation or tarsal strip procedure to address inward eyelid margin malposition.
Common Pitfalls
- Billing E196 in conjunction with E197 (Ectropion repair) on the same eyelid is generally disallowed as it represents contradictory surgical goals for the same anatomical structure.
- Failing to append the E948 code when a mucous membrane graft is harvested and utilized during the same operative session results in significant under-billing.
Billing Tips
- Always ensure the surgical report clearly differentiates the technique from a Zeigler puncture to justify the higher fee associated with E196.
- If performing a repeat procedure on a previously operated eyelid, ensure E945 is claimed alongside E196 to capture the increased complexity of secondary surgery.
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