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E935
E935 – Primary bone graft reconstruction (separate site) in addition to local repair, bilateral
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on fee for the surgical repair of bilateral fractures of the orbit with maxilla. It is claimed by the surgeon in addition to the primary procedure code, for example F142 for repair with wiring and local fixation.
When to Use
- Use E935 exclusively as an add-on when performing a primary bilateral orbital/maxillary fracture repair, such as F142, that specifically requires a separate site bone graft.
- Apply this code when the reconstruction involves harvesting bone from a donor site (e.g., calvarium or iliac crest) to address bilateral defects during the same operative session as the primary fixation.
Common Pitfalls
- Billing E935 without a valid primary procedure code like F142 will result in an automatic rejection.
- Attempting to claim E935 alongside restricted codes Z263, Z264, Z265, Z266, E975, or E976 will trigger a billing error due to the explicit prohibition in the Schedule of Benefits.
- Failure to document the separate site harvest and the specific bilateral nature of the reconstruction often leads to audit recovery.
Billing Tips
- Ensure E935 is submitted on the same claim record as the primary procedure to maintain the link required for add-on eligibility.
- If the procedure qualifies as a trauma case, ensure the Injury Severity Score (ISS) is documented in the medical record to support the application of the E420 trauma premium.
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