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E375
E375 – Repeat fusion premium
OHIP Surgical Assists Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
The E375 premium provides a 30% increase to the fee of a major spinal fusion procedure when the surgery is a repeat fusion. This premium is only applicable to a specific list of major fusion codes with 'E' or 'N' prefixes as detailed in the Schedule of Benefits on page :.
When to Use
- Use E375 when performing a revision spinal fusion procedure on a patient who has previously undergone a fusion at the same spinal level.
- Apply this premium when the primary procedure code is one of the designated 'E' or 'N' prefix codes listed in the Schedule of Benefits, such as E363 or N516, and the surgery involves re-entering the previously operated site.
Common Pitfalls
- Billing E375 for a fusion at a different spinal level than the original surgery, which does not meet the criteria for a 'repeat' fusion.
- Applying E375 to non-major fusion codes or procedures not explicitly listed in the Z13 section of the Schedule of Benefits, leading to automatic claim rejection.
- Failing to link E375 to the primary procedure code, which prevents the 30% premium calculation from triggering correctly.
Billing Tips
- Ensure the primary procedure code (e.g., N513 or E369) is submitted on the same claim as E375 to ensure the 30% fee increase is applied to the base rate.
- Verify that the surgical report clearly identifies the procedure as a revision or repeat fusion to justify the use of E375 during a potential post-payment audit.
Percentage Premium: 0.3%
This code applies a percentage increase to the base procedure fee
Provider Fee$0.01
Effective: July 1, 2013
Category
Z. Spinal Surgical Procedures
Subcategory
SPINAL SURGICAL PROCEDURES
Service Type
PercentageIncrease
Code Classes
Other Premiums (including After Hours Procedure Premiums), Spinal Surgical Procedures
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