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E218
E218 – Dacryocystorhinostomy
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Dacryocystorhinostomy is a surgical repair procedure that creates a fistula between the lacrimal sac and the nasal cavity to bypass an obstruction in the nasolacrimal duct. This procedure is indicated for patients with epiphora (excessive tearing) or dacryocystitis (inflammation of the lacrimal sac). The service is eligible for surgical assistant and anaesthesiologist services, each with their own base units and time-based calculations.
When to Use
- Use E218 for the primary surgical creation of a fistula between the lacrimal sac and nasal cavity to address chronic epiphora due to nasolacrimal duct obstruction.
- Use E218 when performing dacryocystorhinostomy for recurrent dacryocystitis where conservative management has failed.
Common Pitfalls
- Do not bill E218 concurrently with E215, E216, or E217 as these are considered inclusive or alternative procedures for lacrimal system pathology.
- Failure to document the specific necessity of a concurrent lacrimal bypass or canalicular reconstruction will lead to the rejection of the E954 add-on code.
- Billing a standard hospital admission assessment is prohibited; only the major pre-operative visit (consultation) is eligible for payment alongside the surgical fee.
Billing Tips
- Always append E954 if a Lester Jones tube or canalicular reconstruction is performed during the same operative session to capture the additional $183.55 fee.
- Ensure the patient's age is accurately reflected in the claim to automatically trigger the age-based premium (up to 30% increase) for patients under 16 years old.
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