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E501
E501 – Cleft lip - with nasal cartilage realignment
OHIP Surgical Assists Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on code to be claimed with `S013` (Cleft lip, unilateral) when nasal cartilage realignment is performed as part of the same procedure.
When to Use
- Use E501 exclusively as an add-on to S013 when the primary unilateral cleft lip repair includes the specific surgical realignment of nasal cartilage.
- Apply this code when the surgical note explicitly details the mobilization and repositioning of the nasal cartilages to address the nasal deformity associated with the cleft.
Common Pitfalls
- Billing E501 without S013 will result in an automatic rejection, as it is strictly an add-on code.
- Attempting to bill E501 alongside M030, M031, or M032 is prohibited; these codes are mutually exclusive with cleft lip reconstruction procedures.
- Failure to document the specific nasal cartilage realignment steps in the operative report poses a significant audit risk for the add-on fee.
Billing Tips
- Ensure the age of the patient is clearly identified at the time of service to automatically trigger the appropriate age-based percentage premium (e.g., under 30 days or under 1 year) on top of the E501 fee.
Provider Fee$304.30
Effective: April 1, 2025
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Service Type
Procedure
Code Classes
Digestive System Surgical Procedures
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