E378 – 3D stereotactic spinal procedure
OHIP Surgical Assists Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
A 3D stereotactic spinal procedure is an add-on service used in conjunction with other primary spinal surgeries. It is payable in addition to procedures for posterior spinal arthrodesis, open reduction of spinal fractures (e.g., N572, N573), and correction of spinal deformities (e.g., N539, N540). This service provides advanced 3D image guidance to the surgeon during the operation.
When to Use
- Use when performing complex posterior spinal arthrodesis (e.g., N572 or N573) where a surgical navigation system is required to track tools against pre-operative or intra-operative 3D reformatted images.
- Use during the correction of spinal deformities (e.g., N539 or N540) when 3D computer-assisted stereotactic navigation is essential for precise hardware placement relative to patient anatomy.
Common Pitfalls
- Billing E378 when using standard 2D intra-operative fluoroscopy or 'live' imaging without a 3D surgical navigational system will result in audit recovery.
- Failing to document the specific use of a 3D navigational system that generates axial, sagittal, and coronal reformatted images is a frequent cause of claim rejection.
- Attempting to bill E378 for procedures that do not involve the required 3D virtual representation of anatomy, even if advanced imaging technology was present in the OR.
Billing Tips
- Ensure your operative report explicitly describes the use of the 3D navigational system and the tracking of surgical tools, as this is the primary documentation requirement for audit compliance.
- Confirm that the primary procedure (e.g., N572, N539) is eligible for the add-on, as E378 is strictly an add-on service and cannot be billed as a standalone procedure.
Effective: April 1, 2025
Z. Spinal Surgical Procedures
SPINAL SURGICAL PROCEDURES
Procedure
Spinal Surgical Procedures
Three-dimensional (3D) computer-assisted stereotactic navigation (E378) must include the pre-operative or intra-operative generation of axial, sagittal and coronal reformatted images that are processed and virtually represented in 3D by a surgical navigational system.
The surgical navigational system must be used to reflect the position of an image-guided (tracked) surgical tool(s) relative to the patient's anatomy.
The use of an intra-operative imaging tool such as a portable x-ray, fluoroscope (2D or 3D), CT, MRI or ultrasound for "live" localization without a surgical navigational system as defined above does not constitute E378 or E379 and is not eligible for payment.
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