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E968
E968 – LeFort I cleft palate - in three segments
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on code to be used in conjunction with R580 (LeFort I cleft palate in one segment). This fee is claimed when the surgical procedure requires the maxilla to be sectioned and repositioned in three segments.
When to Use
- Use this code exclusively as an add-on to R580 when the surgical plan and execution involve sectioning the maxilla into exactly three distinct segments.
- Apply this code when the complexity of the cleft palate repair necessitates a multi-segment osteotomy to achieve proper maxillary alignment.
Common Pitfalls
- Billing E968 in conjunction with E967 is a common error; these codes are mutually exclusive as they represent different segment counts.
- Submitting E968 without the primary procedure code R580 will result in an automatic rejection, as it is strictly an add-on service.
- Failing to clearly document the three-segment osteotomy in the operative report increases the risk of recovery during an audit.
Billing Tips
- Ensure the primary procedure R580 is listed first on the claim, followed by E968, to maintain the correct hierarchical relationship for OHIP processing.
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