E197 – Ectropion, other than Zeigler puncture
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the repair of ectropion, which is the outward turning of an eyelid. This service is for repairs performed by methods other than Zeigler puncture (see Z860). The '#' prefix indicates that when performed in a hospital or ICHSC, the facility costs (premises, equipment, supplies, personnel) are funded by the respective institution and not billed by the physician (). If a skin graft is required, refer to the Plastic Surgery Procedures in the Integumentary System section of the Schedule.
When to Use
- Use E197 for formal surgical repairs of ectropion, such as horizontal lid tightening or wedge resections, where the Zeigler puncture method (Z860) is not utilized.
- Select E197 when performing a surgical correction of ectropion that does not involve a skin graft, as skin graft procedures must be billed under the Integumentary System section.
Common Pitfalls
- Billing E197 in conjunction with Z860 for the same eyelid is a common error that will trigger a rejection due to the restricted code relationship.
- Failing to bill the procedure as a '#' code when performed in a hospital setting will result in an audit flag for claiming facility fees that are already covered by the institution.
Billing Tips
- If you are the second surgeon performing a repeat ectropion repair, ensure you append E945 to your claim to receive the additional $81.00 fee.
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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