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E937
E937 – Pterygium - with autogenous conjunctival transplant
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Payable in addition to the primary procedure fee when an autogenous conjunctival transplant is performed. This add-on applies to the following services: - Pterygium excision, such as simple (E206), with partial keratectomy (E205), or with lamellar graft (E207). - Fornix reconstruction, such as E176 or E177. - Excision of a conjunctival lesion (E210).
When to Use
- Use E937 when performing a pterygium excision (E205, E206, or E207) specifically utilizing an autogenous conjunctival graft to cover the bare sclera.
- Use E937 in conjunction with E210 when a conjunctival lesion excision requires a conjunctival autograft for reconstruction.
- Use E937 when performing fornix reconstruction (E176 or E177) that necessitates the transfer of autogenous conjunctival tissue.
Common Pitfalls
- Billing E937 without a valid primary procedure code (E205, E206, E207, E176, E177, or E210) will result in an automatic rejection.
- Attempting to bill E937 for amniotic membrane grafts is incorrect, as this code is strictly defined for autogenous conjunctival transplants.
- Claiming E937 for simple pterygium excision (E206) that does not involve a graft will trigger an audit for inappropriate billing.
Billing Tips
- Ensure the primary procedure code is listed first on the claim to establish the surgical context required for the E937 add-on.
- Verify that the operative report explicitly documents the harvesting and suturing of the autogenous conjunctival graft to support the use of E937.
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