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T523
T523 – T523
OHIP Other Code · Schedule of Benefits
When to Use
- Use T523 for the surgical excision of a malignant lesion of the eyelid where the defect requires a complex reconstruction, such as a rotational flap or graft, rather than simple primary closure.
- Select T523 when the procedure involves a full-thickness excision of an eyelid malignancy that necessitates reconstruction of the tarsus and conjunctiva, distinguishing it from simpler excision codes like E791.
Common Pitfalls
- Billing T523 alongside simple excision codes for the same site is considered unbundling; the reconstruction is inclusive of the excision.
- Submitting T523 without clear documentation of the reconstructive technique (e.g., flap type or graft source) often triggers manual review or rejection for lack of medical necessity for the higher fee.
Billing Tips
- Ensure the operative report explicitly describes the complexity of the reconstruction to justify the higher fee compared to standard excision codes, as auditors look for evidence of tissue rearrangement.
Provider Fee$513.65
Specialist Fee$513.65
Effective: February 1, 2011
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