E201 – Excision of skin with removal of orbital fat and/or major lid fold reconstruction - one lid
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Excision of skin, with or without partial excision of the orbicularis oculi muscle - one lid, plus removal of orbital fat and/or major lid fold reconstruction - one lid.
When to Use
- Use for functional blepharoplasty involving the excision of skin and removal of orbital fat where the patient meets the specific Ministry of Health criteria for visual field obstruction.
- Use for major lid fold reconstruction when the procedure involves significant structural modification beyond simple skin excision.
Common Pitfalls
- Billing E201 for purely cosmetic blepharoplasty, which is not an insured service and will lead to audit recovery.
- Failing to obtain and document prior Ministry of Health approval, which is a mandatory requirement for this code as per Appendix D.
- Billing E201 alongside other lid procedures without ensuring the services are not considered 'included' in the global surgical fee for the primary procedure.
Billing Tips
- Ensure the medical record explicitly documents the functional impairment, such as superior visual field loss, to justify the medical necessity required for Ministry approval.
- When performing bilateral procedures, ensure the claim is submitted with the appropriate bilateral indicator or suffix as required by the Schedule of Benefits to avoid rejection.
Effective: April 1, 2025
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures
Medical record must establish that an insured service was provided, the service submitted is the service that was rendered, and the service was medically necessary.
Blepharoplasty is only insured in those circumstances described in the Appendix D - prior approval of the Ministry of Health is required.
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