E216 – Lacerated canaliculus - immediate repair
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Immediate surgical repair of a lacerated canaliculus. This is a surgical procedure listed under the Lacrimal Tract section on page of the Schedule of Benefits. As a surgical procedure, payment rules for surgical assistants (suffix B) and anaesthesiologists (suffix C) apply. This service may be eligible for supervision payments when performed by a Medical Trainee under the guidance of a Supervising Physician, as per the rules outlined in to . Assistant and anaesthesia fees are calculated based on 6 base units plus time units.
When to Use
- Use E216 for the primary, immediate surgical repair of a full-thickness or partial-thickness laceration of the lacrimal canaliculus, typically involving stent placement.
- Select E216 when performing the repair as a distinct surgical procedure, as opposed to simple eyelid laceration repair (e.g., S061 or S062) which does not involve the lacrimal drainage system.
Common Pitfalls
- Billing E216 alongside eyelid laceration repair codes (e.g., S061) without clear documentation of separate anatomical involvement may trigger a rejection for unbundling.
- Failing to include the Injury Severity Score (ISS) in the medical record when claiming the E420 trauma premium for qualifying patients will result in a clawback during audit.
- Assuming E216 is eligible for a second surgical assistant without prior authorization; unlike some major trauma codes, E216 requires specific consultant approval for a second assistant.
Billing Tips
- Always append the appropriate age-based premium (e.g., AGE_PREMIUM_LT16Y) to the E216 claim, as these are often missed in pediatric ocular trauma cases.
- If the procedure is performed after hours, ensure the start time is clearly documented to support the use of E409 or E410, as these premiums are strictly time-dependent.
Effective: April 1, 2026
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures
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