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E364
E364 – Each additional disc level fused
OHIP Surgical Assists Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
This service is for the fusion of each additional disc level and is only payable in addition to a primary spinal arthrodesis procedure without instrumentation. It is applicable for: - Anterior cervical arthrodesis without instrumentation (to E363). - Anterior thoracic/lumbar arthrodesis without instrumentation (to E367). - Posterior cervical, thoracic, & lumbar arthrodesis following decompression or osteotomy (to E369). - Posterior cervical & thoracic arthrodesis as a sole procedure (to N514 or N519). - Posterior lumbar arthrodesis as a sole procedure (to N581).
When to Use
- Use E364 to bill for every disc level fused beyond the first level when performing an anterior cervical arthrodesis (E363) or anterior thoracic/lumbar arthrodesis (E367).
- Use E364 for each additional level fused during posterior spinal arthrodesis procedures (N514, N519, N581) when instrumentation is not utilized.
- Use E364 for each additional level fused following a decompression or osteotomy (E369) where the primary procedure covers only the first level.
Common Pitfalls
- Billing E364 when instrumentation is present; this code is strictly for procedures without instrumentation and will be rejected if associated with instrumented fusion codes.
- Claiming E364 as a standalone code; it is an add-on code that must be linked to an eligible primary arthrodesis procedure on the same claim.
- Under-billing the number of units; E364 must be claimed with a unit count corresponding to the total number of additional levels fused beyond the primary level.
Billing Tips
- Ensure the primary procedure code (e.g., E363, N581) is billed as the first line item to establish the base procedure before adding E364 units.
- Document the specific levels fused in the operative report to justify the total unit count of E364 claimed, as this is a frequent target for post-payment audits.
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