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T264
T264 – T264
OHIP Other Code · Schedule of Benefits
When to Use
- Use T264 for the primary repair of a laceration of the eyelid involving the margin, requiring precise anatomical reconstruction.
- Apply this code when the injury involves the full thickness of the eyelid, distinguishing it from superficial skin lacerations billed under minor surgery codes like Z001.
- Select T264 when the procedure is performed in an operating room setting for complex trauma requiring specialized ophthalmic instrumentation.
Common Pitfalls
- Billing T264 in conjunction with an office visit code (A007) is generally disallowed as the visit is considered included in the surgical fee.
- Attempting to bill T264 alongside other eyelid procedures without proper documentation of separate anatomical sites will lead to automatic rejection for duplicate service.
- Failure to include the appropriate diagnostic code for the specific nature of the trauma often results in claim rejection by OHIP.
Billing Tips
- Ensure the operative report clearly describes the involvement of the eyelid margin, as this is the key differentiator for this specific fee code.
- If multiple eyelids are repaired during the same session, apply the appropriate multiple procedure rules (e.g., 100% for the first, 85% for the second) to avoid payment errors.
Provider Fee$274.34
Specialist Fee$274.34
Effective: February 1, 2011
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