E321 – Posterior/superior canal occlusion
OHIP Surgical Assists Code — Y. Ocular and Aural Surgical Procedures · Schedule of Benefits
Posterior/superior canal occlusion, listed under Inner Ear Repair in the Schedule of Benefits. This service is a surgical procedure and is eligible for surgeon, assistant, and anaesthesia fees. - Surgeon (E321A): The fee is for the primary surgeon performing the procedure. - Assistant (E321B): The fee is calculated based on 6 base units plus time units as per -. - Anaesthesia (E321C): The fee is calculated based on 8 base units plus time units as per -.
When to Use
- Use E321A for the surgical occlusion of the posterior or superior semicircular canal in patients with intractable benign paroxysmal positional vertigo (BPPV) who have failed conservative repositioning maneuvers.
- Use this code for canal plugging procedures performed via transmastoid approach to address symptomatic canalithiasis.
Common Pitfalls
- Attempting to bill a hospital admission assessment separately; this is disallowed unless it qualifies as the 'major pre-operative visit' for the procedure.
- Failing to recognize that when multiple surgical procedures are performed under the same anaesthetic, assistant and anaesthesia base units are restricted to the major procedure only.
- Incorrectly applying after-hours or trauma premiums to the base fee without ensuring the procedure meets the strict 'non-elective' or 'delayed elective' criteria defined in GP104.
Billing Tips
- Ensure the surgical assistant (E321B) and anaesthesiologist (E321C) claims are linked to the primary surgeon's E321A claim to facilitate accurate processing of base and time units.
- If the patient is under 16 years of age, verify the correct age-based premium (e.g., 10% for 5-16 years) is applied to the procedural fee as per GP64.
Effective: April 1, 2025
Y. Ocular and Aural Surgical Procedures
Y. Ocular and Aural Surgical Procedures
Surgical
Ocular and Aural Surgical Procedures
All insured services must be documented in appropriate medical records, establishing that the service was provided, is the service for which the account is submitted, and was medically necessary, as per .
Listed with 6 base units for surgical assistant () and 8 base units for anaesthesiologist ().
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