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E205
E205 – Pterygium - with partial keratectomy
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
When to Use
- Use E205 when performing a formal excision of a pterygium that necessitates a partial keratectomy to clear the corneal surface.
- Use E205 as the primary procedure code when performing a pterygium excision combined with an autogenous conjunctival transplant (E937) or a mucous membrane graft (E948).
Common Pitfalls
- Do not bill E205 for simple conjunctival excisions or superficial lesions that do not involve a partial keratectomy; use E210 for those cases.
- Avoid billing E205 in conjunction with E206 or E207, as these represent different levels or types of pterygium management and are generally considered mutually exclusive for the same eye.
- Failure to document the specific use of a partial keratectomy can lead to audit recovery if the procedure is later reclassified as a simpler conjunctival excision.
Billing Tips
- Always append the appropriate add-on code (E937 for autogenous conjunctival transplant or E948 for mucous membrane graft) on the same claim to ensure full compensation for the graft work.
- If the procedure is performed on a patient under 16 years of age, ensure the relevant age premium is applied to the E205 fee, as this is a surgical procedure in Part Y.
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