E186

PDF page 114 / GP100

Ocular Surgery, Cystoscopy, and Examination Under Anaesthesia
               E023C Anaesthesia service for E138, E139, E140, E141, E144, E145,
                        E146, E186, E187, E149, Z432, Z606, or Z607
                         ............................................. 6 basic units, plus time units.
      Colonoscopy and Sigmoidoscopy
   E032C Anaesthesia service for Z491, Z492, Z493, Z494, Z495, Z496,
                Z497, Z498, Z499, Z555 or Z580
                .............................................. 4 basic units, plus time units
        [Commentary:
        1.Deep sedation, general anaesthesia or regional anaesthesia, performed by an
          anaesthesiologist, are examples of anaesthesia that may be rendered for E023C and E032C.
        2.Anaesthesia extra units listed on GP97 are eligible for payment with E023C and E032C.
        3.Local infiltration or topical anaesthesia used as an anaesthetic for any procedure is not
          eligible for payment.]
        Note:
        For the purposes of anaesthesia services the following definitions apply:
        1.Procedural Sedation is a drug-induced depression of consciousness during which patients
          respond purposefully to verbal commands, either alone or accompanied by light tactile
          stimulation. No interventions are required to maintain a patent airway, and spontaneous
          ventilation is adequate. Cardiovascular function is usually maintained.
        2.Deep Sedation is a drug-induced depression of consciousness during which patients cannot
          be easily aroused but respond purposefully following repeated or painful stimulation. The
          ability to independently maintain ventilatory function may be impaired. Patients may require
          assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate.
          Cardiovascular function is usually maintained.
        3.General Anaesthesia is a drug-induced loss of consciousness during which patients are not
          arousable, even by painful stimulation. The ability to independently maintain ventilatory
          function is often impaired. Patients often require assistance in maintaining a patent airway,
          and positive pressure ventilation may be required because of depressed spontaneous
          ventilation or drug-induced depression of neuromuscular function. Cardiovascular function
          may be impaired.
  ANAESTHESIA ADMINISTERED BY SAME PHYSICIAN PERFORMING A PROCEDURE
    1. Except as described in paragraph 2, when a physician administers an anaesthetic, nerve block
       and/or other medication prior to, during, immediately after or otherwise in conjunction with a
       diagnostic, therapeutic or surgical procedure which the physician performs on the same patient,
       the administration of the anaesthetic, nerve block and/or other medication is not eligible for
       payment.

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 773 / Y7

OCULAR SURGICAL PROCEDURES
 VITREOUS
                                                                                 Asst      Surg      Anae
         11.E149 is not eligible for payment at the time of surgery when the agent administered (e.g.
           antibiotics or steroids) is in relation to the condition being addressed by the primary operative
           procedure. E149 is only eligible for payment in addition to the primary operative procedure
           where there is a clearly separate unrelated diagnosis and E149 is the primary treatment for
           the separate unrelated condition.
         [Commentary:
         1.Current research supports “treat and extend” injection protocols with most studies supporting
           that an average of approximately 8 injections per year will control disease. Patients should
           only receive more than 8 injections per year in the presence of clinical and diagnostic
           evidence of disease instability.
         2.Refer to E023C on GP100 for anaesthesia services other than procedural sedation rendered
           in support of E186, E187, or E149.
         3.Local infiltration or topical anaesthesia used as an anaesthetic for any procedure is not
           eligible for payment.]

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 1012. Record Layout PDF, page 1.

E18620260401999999990000090000000000000000000009000000000079800000000798000

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.