E226 – Lower or upper eyelid bridge flap - second stage
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
This procedure represents the second stage of a lower or upper eyelid bridge flap (E225). General rules for surgical procedures and anaesthesia from the Schedule of Benefits apply.
When to Use
- Use E226 specifically for the division and inset of the pedicle flap after the initial reconstruction performed under E225.
- Apply this code when the bridge flap has achieved sufficient vascularization from the recipient site to allow for separation from the donor site.
Common Pitfalls
- Billing E226 on the same date of service as E225 is a common rejection; the second stage must occur after the healing interval required for the flap to integrate.
- Failing to link the procedure to the original excision code (such as E977) in the patient record can lead to audit scrutiny regarding the necessity of the multi-stage reconstruction.
Billing Tips
- Ensure the claim for E226 clearly indicates the surgical date, as it must be distinct from the E225 date to avoid automated system denials for duplicate or overlapping procedures.
- If the second stage involves additional excision for tumor-free margins, ensure E977 is appended to the E226 claim to capture the 25% premium where applicable.
Effective: April 1, 2025
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures, Anaesthesiologists' Services
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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