E215 – Dacryocystectomy
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Dacryocystectomy is the surgical removal of the lacrimal sac. This service is listed under the Ocular and Aural Surgical Procedures section. The fee listed is for the surgeon, with separate calculations for surgical assistant and anaesthesia services based on basic and time units.
When to Use
- Use E215 for the definitive surgical excision of the lacrimal sac, typically indicated for chronic dacryocystitis unresponsive to conservative management or dacryocystorhinostomy.
- Select E215 when the clinical objective is the complete removal of the sac, distinguishing it from simple incision and drainage procedures like E939.
Common Pitfalls
- Billing E215 in conjunction with other lacrimal procedures performed during the same session without accounting for the multiple procedure rule, which limits payment for secondary procedures.
- Failure to document the specific surgical indication, which can lead to audit scrutiny regarding the necessity of a dacryocystectomy versus less invasive alternatives.
Billing Tips
- Ensure that if a surgical assistant is utilized, their claim is linked to the E215 procedure code to correctly trigger the assistant fee calculation based on the E215 basic units.
- If the procedure is performed on an emergency basis after hours, append the appropriate premium (E409 or E410) to the E215 claim to ensure the 50% or 75% increase is applied to the procedural fee.
Effective: April 1, 2025
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures
All insured services must be documented in appropriate records to establish that the service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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