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E938
E938 – Vitreous - with transscleral retinal suturing
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
This service represents transscleral retinal suturing. It is listed in the Schedule in direct relation to E148 (Vitrectomy, complete and by posterior approach, with vitreous exchange), indicating it is performed as an associated procedure. The fee for E938A is for the surgical component only. As a surgical service, it is subject to standard payment rules, including eligibility for age-based and after-hours premiums.
When to Use
- Use E938 as an add-on procedure when performing transscleral retinal suturing during a vitrectomy (E148).
- Use this code when the surgical plan specifically requires securing the retina via transscleral sutures in conjunction with primary vitreous surgery.
Common Pitfalls
- Billing E938 as a standalone procedure without an associated vitrectomy (E148) will result in a rejection or audit flag.
- Failing to document the specific necessity of the transscleral suturing in the operative report can lead to recovery of funds during a post-payment audit.
Billing Tips
- Ensure E938 is submitted on the same claim as E148 to maintain the link between the primary vitrectomy and the associated suturing procedure.
- Apply age-based premiums (GP64) or after-hours premiums (E409/E410) to the E938 fee when the clinical criteria for those specific premiums are met.
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