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E394
E394 – Artificial disc insertion - additional level
OHIP Surgical Assists Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
This code is payable for each additional level of artificial disc insertion performed during the same surgical session as a primary artificial disc insertion (N525 or N526). It accounts for the surgical work of replacing a subsequent disc at a different level during the same operation. As per the note on page of section , no other services from the Spinal Surgical Procedures section are payable with N525 or N526, with the explicit exception of E394.
When to Use
- Use E394 when performing a multi-level artificial disc replacement where a primary procedure (N525 or N526) is billed for the first level.
- Apply this code for each additional, distinct spinal level beyond the primary level addressed during the same operative session.
Common Pitfalls
- Billing E394 without an associated N525 or N526 claim will result in an automatic rejection, as it is strictly an add-on code.
- Attempting to bill other spinal surgical procedure codes alongside N525 or N526 is prohibited; E394 is the only exception permitted under section Z4.
- Failure to clearly document the specific spinal levels treated can lead to audit scrutiny regarding the necessity of multiple levels.
Billing Tips
- Ensure E394 is submitted on the same claim as the primary N525 or N526 to maintain the required billing link.
- Verify that no other codes from the Spinal Surgical Procedures section are included in the claim, as the Ministry strictly enforces the exclusivity rule for these procedures.
Provider Fee$765.00
Effective: April 1, 2025
Category
Z. Spinal Surgical Procedures
Subcategory
SPINAL SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Spinal Surgical Procedures
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