All codes
E206
E206 – Pterygium - simple (unilateral)
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
E206 is for the simple excision of a pterygium on one eye. A pterygium is a triangular-shaped, benign growth of the conjunctiva that can grow onto the cornea and may affect vision. This procedure does not include more complex techniques like partial keratectomy (E205), lamellar graft (E207), autogenous conjunctival transplant (E937), or mucous membrane graft (E948). The fee for the surgical procedure (suffix A) is a flat rate. The fee for anaesthesia (suffix C) is calculated based on 6 base units plus time units as per the rules on .
When to Use
- Use E206 for the simple, unilateral excision of a pterygium where no graft or complex keratectomy is performed.
- Choose E206 when the procedure is limited to the conjunctival growth and does not involve the advanced techniques described in E207, E937, or E948.
Common Pitfalls
- Billing E206 when a conjunctival autograft (E937) or lamellar graft (E207) was actually performed, which will lead to audit discrepancies.
- Attempting to bill E206 alongside E205 (partial keratectomy) is redundant, as E205 is intended for more complex corneal involvement that exceeds the scope of a simple pterygium excision.
Billing Tips
- Ensure the surgical report clearly distinguishes the procedure as a simple excision to justify the use of E206 over the higher-valued graft-based codes.
- When billing anaesthesia (E206C), remember to append the appropriate extra units for ASA status or patient age, as these are not automatically calculated by the base code.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.