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E967
E967 – LeFort I cleft palate - in two segments
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Add-on fee for a LeFort I osteotomy for a cleft palate when the procedure is performed in two segments. This fee is added to the fee for the primary procedure, R580 (LeFort I cleft palate in one segment).
When to Use
- Use E967 only when a LeFort I osteotomy is performed specifically for a cleft palate patient and the maxilla is surgically divided into two distinct segments.
- This code must be appended to the primary procedure R580 to account for the additional surgical complexity of segmenting the maxilla.
Common Pitfalls
- Billing E967 without R580 will result in an automatic rejection, as E967 is strictly an add-on code dependent on the primary procedure.
- Confusing E967 with codes for multi-segment osteotomies in non-cleft patients (such as standard orthognathic surgery codes) will lead to audit recovery.
Billing Tips
- Ensure the operative report explicitly documents the division of the maxilla into two segments to justify the use of E967 over the base R580 fee.
- Remember that age-based premiums (e.g., AGE_PREMIUM_5_TO_16_YEARS) apply to the total value of the procedure, including the E967 add-on.
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