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E948
E948 – Entropion - with mucous membrane graft
OHIP Surgical Assists Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
The E948 is an add-on payment for a mucous membrane graft performed during specific ocular surgeries. It is not a standalone procedure and must be billed with a primary procedure code. It is listed as an add-on for: - Pterygium excision (see page for context with E206, E205, E207). - Entropion repair (E196), as listed on page . - Excision of conjunctival lesion (E210), as listed on page .
When to Use
- Use E948 as an add-on when performing a mucous membrane graft specifically to address cicatricial entropion during an E196 repair.
- Apply E948 when performing a graft during a pterygium excision (E205, E206, or E207) to prevent recurrence in high-risk cases.
- Use E948 when harvesting and placing a mucous membrane graft during the excision of a conjunctival lesion (E210).
Common Pitfalls
- Billing E948 as a standalone procedure will result in an automatic rejection; it must be linked to a primary surgical code on the same claim.
- Attempting to bill E948 for procedures not explicitly listed in the Schedule of Benefits (such as general eyelid reconstruction not involving mucous membrane grafts) will lead to audit recovery.
- Failing to document the specific site of the graft harvest and placement can lead to claims being flagged during post-payment reviews.
Billing Tips
- Ensure E948 is submitted on the same claim as the primary procedure (e.g., E196 or E206) to ensure the system recognizes the surgical relationship.
- Verify that the primary procedure code is one of the approved surgical codes, as E948 is strictly restricted to the specific ocular procedures defined in the Schedule of Benefits.
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