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T542
T542 – T542
OHIP Other Code · Schedule of Benefits
When to Use
- Use T542 for the surgical repair of a complex or extensive laceration of the eyelid involving the full thickness of the lid margin.
- Apply this code when the procedure requires formal reconstruction techniques, such as a pentagonal wedge resection or similar tissue advancement, rather than simple suturing.
- Select T542 when the complexity of the eyelid repair exceeds the scope of minor laceration repairs typically billed under A001 or similar minor surgical codes.
Common Pitfalls
- Billing T542 alongside simple laceration repairs for the same site will trigger a rejection for duplicate or overlapping services.
- Failure to document the full-thickness nature of the lid involvement often leads to audit downgrades to lower-valued minor surgical codes.
- Attempting to bill an additional tray fee or minor procedure code for the same anatomical site is prohibited as the complexity is already captured in the T542 fee.
Billing Tips
- Ensure the operative report explicitly details the involvement of the lid margin and the specific reconstructive technique used to justify the high-value fee.
- If additional procedures are performed on the same eye, ensure they are distinct and unrelated to the eyelid repair to avoid bundling denials.
Provider Fee$1,321.18
Specialist Fee$1,321.18
Effective: February 1, 2011
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