E175

PDF page 768 / Y2

OCULAR SURGICAL PROCEDURES
CORNEA
                                                                                                     Asst         Surg         Anae
    INCISION
# Z851 Therapeutic paracentesis .......................................................      70.00 6
# E175     - therapeutic paracentesis done in conjunction with E186,
             E187 or E149 ............................................................. add  20.00
# Z844 Diagnostic Paracentesis for: 1) suspected intraocular infection;
           2) intraocular inflammation / uveitis; or 3) suspected cancer
           involving the intraocular structures or fluids .......................           100.00 6
      Payment rules:
      1.Z851 is not eligible for payment for same patient same day as E175 or Z844.
      2.Z851 and Z844 are not eligible for payment for same patient same day as E186, E187, or
        E149.
      3.Z844 is only eligible for payment if the sample obtained through paracentesis is sent for one
        or more of the following:
         a.culture
         b.cellular analysis
         c.molecular analysis
       CORNEAL CROSS-LINKING
         Corneal Cross Linking (CXL) is eligible for payment if the patient has one of the following
         medical indications:
        a. Mild to moderate progressive keratoconus;
        b. Corneal thinning or ectasia following laser photorefractive or phototherapeutic surgery;
        c. Pellucid marginal corneal degeneration; and
        d. Recurrent keratoconus after corneal transplantation.
  E202 Corneal cross-linking .............................................................. 200.00
      Payment rules:
      E202 is not eligible for payment for the same patient and performed on the same day as E117.

PDF page 772 / Y6

Injections and/or paracentesis
# E186 Intravitreal injection of medication for the treatment of wet
           macular degeneration, left eye ............................................               nil          90.00          5
# E187 Intravitreal injection of medication for the treatment of wet
           macular degeneration, right eye..........................................                 nil          90.00          5
# E149 Vitreous injection or aspiration, posterior with needle for culture
          and/or injection of medication, other than for macular
          degeneration .......................................................................       nil          90.00          5
# E175    - therapeutic paracentesis, to E186, E187, or E149 .....add                                             20.00
# E142 Preretinal membrane peeling or segmentation to include
            vitrectomy, complete and by posterior approach, with or
            without vitreous exchange (air, gas, or artificial vitreous
            substance) .......................................................................... 6 920.00 6
      Payment rules:
      1.E186 and E187 are each limited to 12 per patient per 12-month period. Services in excess of
        this limit are only eligible for payment in exceptional circumstances where warranted by
        clinical conditions. Physicians must document the appropriate clinical indications for services
        in excess of the limit on the patient’s permanent medical record.
         2.Time units and anaesthesia extra units listed on GP97 are not eligible for payment with
           anaesthesia services for E186C, E187C, or E149C.
         3.E003C is not payable for anaesthesia services rendered for E186, E187, or E149.
         4.If paracentesis is performed through the same site as E186, E187, or E149, E175 is not
           eligible for payment.
         5.E148, E142, E149, E186, E187, E175, Z851 are not eligible for payment with E112
         6.E940 is not eligible for payment with E142 or E148.
         7.E154 is not eligible for payment with E142 except when extensive pan-retinal laser
           coagulation is required to treat underlying pathology resulting in two separate procedures
           being performed and each are documented in the medical record.
         8.E151 is only eligible for payment with E142 or E148 when laser is performed to treat a retinal
           detachment with presence of subretinal fluid, in association with the vitrectomy.
         9.E141 is only eligible for payment with E142 or E148 when removal of the lens fragments in
           the posterior vitreous substance requires the use of a separate instrument (fragmatome unit).
         10.E148 and E142 include the removal of silicone oil along with residual vitreous, if performed.

PDF page 774 / Y8

RETINA AND EXTRA OCULAR MUSCLES
                                                                                                             Asst      Surg         Anae
      RETINA
  # E151 Re-attachment of retina and choroid by diathermy,
           photocoagulation or cryopexy as an initial procedure ........                                      6        282.65          6
  # E152 Scleral resection or buckling procedure - with or without
           diathermy, photo-coagulation or cryopexy, primary or
           subsequent procedure........................................................                       6        700.00          7
  # E153 Revision for retinal detachment following unsuccessful
           operation or fresh detachment in the same eye with or
           without diathermy, photocoagulation or cryopexy...............                                     6        840.00          7
  # E161 Removal of scleral implant......................................................                              250.00          6
  # E154 Photocoagulation (xenon, argon laser, etc.) - one eye ...........                                             182.75          6
  # E125 Laser retinopexy for Retinopathy of Prematurity or
           retinoblastoma – one eye ...................................................                                750.00          6
  # E126 Laser retinopexy for Retinopathy of Prematurity or
           retinoblastoma – both eyes ................................................                                1245.00          6
  # E155 Cryopexy - extraocular or sub-conjunctival - one eye.............                205.00 6
  # E112 Pneumatic Retinopexy............................................................ 160.00 6
        Payment rules:
        1.E148, E142, E149, E186, E187, E175 and Z851 are not eligible for payment with E112 on
          the same day.
                                          2.A maximum of one E112 is eligible for payment per eye per day.

Master, record 1001. Record Layout PDF, page 1.

E17520250401999999990000020000000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.