E424 – Partial assessment
OHIP Surgical Assists Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Assessment of paediatric patient with amblyopia (reduced vision in one eye) is the service rendered personally by an ophthalmologist for evaluation of patients 10 years old or less undergoing active treatment through occlusion therapy, penalization, dichoptic therapy, refractive therapy or similar, to maximize vision in the amblyopic eye(s). This premium is payable in addition to A233 or A234.
When to Use
- Use E424 as an add-on to A234 when performing a follow-up assessment for a child under 11 currently undergoing active patching or penalization therapy for amblyopia.
- Apply this code when seeing a patient 10 years of age or younger who is actively using refractive therapy or dichoptic training to manage amblyopia in conjunction with a standard A233 or A234 visit.
Common Pitfalls
- Billing E424 for routine pediatric eye exams that do not involve active amblyopia treatment protocols like occlusion or penalization.
- Submitting E424 for patients who have turned 11, as the code strictly restricts eligibility to patients 10 years old or less.
- Failing to use diagnostic code 368, which is mandatory for this premium to process correctly.
Billing Tips
- Ensure the specific active treatment modality, such as 'occlusion therapy' or 'penalization,' is explicitly noted in the chart to justify the premium during an audit.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Premium
Other Premiums (including After Hours Procedure Premiums)
Service must be rendered personally by an ophthalmologist.
Patient's active treatment (e.g., occlusion therapy, penalization, dichoptic therapy) must be documented.
For evaluation of patients 10 years old or less
Submit claims with diagnostic code 368.
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