E383 – Acute spinal cord injury premium
OHIP Surgical Assists Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
A premium payable to the surgeon for specific spinal surgeries when performed for a patient with an acute spinal cord injury. This is an add-on fee and must be billed in addition to one of the eligible primary procedure codes. Eligible primary procedures include: - Anterior Spinal Decompression: N500, N501, N569, N502, N503, N504, N505, N506, N507, N508, N579 (as per ) - Fractures of the Spine: F201, N572 (as per ) - Tumours/Infections of the Spine: N560, N561 (as per ) - Deformities of the Spine: N539, N540 (as per ) - Procedures Involving Neural Elements: N529, N523, N557, N558, N562 (as per , )
When to Use
- Use E383 when performing an open reduction for a spinal fracture (N572) specifically in the setting of a documented acute spinal cord injury.
- Apply this premium when executing an anterior spinal decompression (e.g., N501) for a patient presenting with acute neurological deficit resulting from trauma.
- Use E383 for the surgical management of acute spinal cord compression caused by an intradural tumour (N561) where the clinical presentation is an acute spinal cord injury.
Common Pitfalls
- Billing E383 for elective spinal surgeries or chronic conditions that do not meet the strict definition of an acute spinal cord injury.
- Failure to link the premium to one of the specific eligible primary procedure codes listed in the Schedule of Benefits, which will result in an automatic rejection.
- Assuming E383 is payable for all spinal surgeries; it is restricted to the specific list of procedures in sections Z3, Z10, Z11, Z12, Z15, and Z16.
Billing Tips
- Ensure your operative report explicitly documents the 'acute' nature of the spinal cord injury to satisfy potential audit requirements for this premium.
- Always verify that the primary procedure code (e.g., N572) is billed on the same claim as E383 to ensure the add-on logic triggers correctly.
Effective: April 1, 2025
Z. Spinal Surgical Procedures
SPINAL SURGICAL PROCEDURES
Premium
Spinal Surgical Procedures, Other Premiums (including After Hours Procedure Premiums)
This is an add-on premium and must be billed in conjunction with an eligible primary spinal surgical procedure.
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