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E395
E395 – Open reduction, additional level, spine fracture/dislocation, anterior/posterior
OHIP Surgical Assists Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
This code represents the surgical service for an open reduction of a spinal fracture or dislocation, using an anterior or posterior approach, for each additional level treated beyond the initial level. It is an add-on code and must be claimed in conjunction with N572 (open reduction, any single level, spine fracture/dislocation, anterior/posterior).
When to Use
- Use E395 for each additional vertebral level requiring open reduction beyond the primary level addressed by N572.
- Apply this code when performing multi-level stabilization for complex spinal fractures or dislocations where multiple segments require surgical reduction.
Common Pitfalls
- Do not bill E395 for decompressive services at the same level as the fracture, as these are considered bundled into the primary procedure N572.
- Avoid claiming E395 as a standalone code; it must be submitted in conjunction with N572 to avoid automatic rejection.
- Failure to document the specific levels treated can lead to audit recovery, as E395 is strictly limited to 'additional' levels beyond the primary.
Billing Tips
- Ensure the primary procedure N572 is billed as the first line item, followed by E395 for each additional level, to maintain correct claim hierarchy.
- If the procedure qualifies for the trauma premium E420, ensure the Injury Severity Score (ISS) is clearly documented in the patient record to support the 50% uplift.
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