E225 – Lower or upper eyelid bridge flap
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
The fee schedule code E225 is for a procedural or surgical service. This is inferred from the master fee record which lists fees for the performing physician (<suffix>A</suffix>), an assistant (<suffix>B</suffix>), and an anaesthetist (<suffix>C</suffix>). As per the General Preamble (, ), fees for assistants and anaesthetists are typically calculated based on basic units and time units, but the specific basic units for E225 are not available. Specific details regarding the nature of the procedure, its requirements, and restrictions are not available in the provided context as the source page was not included.
When to Use
- Use E225 when performing a reconstructive bridge flap for eyelid defects where the tissue is transposed across the lid margin to restore structural integrity.
- Select E225 for complex eyelid repairs that exceed the scope of simple primary closure codes like E220 or E221.
Common Pitfalls
- Billing E225 in conjunction with other eyelid excision codes (e.g., E220) may trigger a rejection for unbundling unless the procedures are performed on separate anatomical sites or involve distinct, non-overlapping surgical steps.
- Failure to document the specific flap technique used can lead to audit recovery if the Ministry determines the procedure performed was a simpler repair code with a lower fee.
Billing Tips
- Always append the E977 add-on code if the procedure is performed in a hospital setting and requires a frozen section to confirm tumour-free margins, as this provides a 25% increase to the E225 fee.
Effective: April 1, 2025
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
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