Secondary Procedure Codes
Review of operative facts that may support additional billable work beyond the primary cataract code.
Cataract & Ophthalmology
Cataract Clinic OHIP Billing: Where the Money Goes Missing
High volume is the advantage and the risk. A small missed amount per case becomes a material revenue leak across hundreds of annual procedures.
900annual cases can support meaningful ROI
8%common estimated missed revenue rate
$142Ksample annual missed revenue finding
The Cataract Billing Problem
Cataract clinics under Bill 60 often run efficient operating days with high case volume and tight administrative workflows. That speed is useful, but it leaves little room for billing review.
Small per-case misses add up fast. Secondary intraoperative procedure codes, anterior vitrectomy billing, assistant fees, and complexity variations may be clinically valid but never make it onto the claim.
The issue is often not the surgery. It is the documentation language. If the operative note does not clearly support the extra work, the billing team may default to the primary code and move on.
Our audit reviews cataract OHIP billing Ontario clinics already submit, compares it with documentation, and separates confident recovery opportunities from workflow improvements for future cases.
Cataract Calculator
Pre-loaded with cataract clinic defaults.
What We Look For
Assistant Fees
Identification of cases where assistant involvement was documented but not reflected in the submitted claim.
Anterior Vitrectomy
Detection of cases where complications or additional intraoperative work may change the billing profile.
IOL Complexity
Review of lens-related complexity variations and whether operative documentation supports billing treatment.
Documentation Language
Coaching on notes that describe clinical work too sparsely for billing confidence.
Rejection Patterns
Analysis of repeat rejection reasons and whether process changes can prevent future leakage.
Case Study Format
A Southern Ontario cataract clinic performing 900 cases per year. Our audit identified $142,000 in annual missed revenue across assistant fees and secondary procedure codes. This is an anonymized example, and recovery estimates are based on OMA data and industry billing audits.
Cataract Audit
See your clinic's exact numbers.
Start with a no-cost sample audit of recent cataract claims and operative notes.
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