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E969
E969 – LeFort I cleft palate - with SMR
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on code representing a Submucous Resection (SMR) performed in addition to a LeFort I osteotomy for a cleft palate, as described by code R580. This service is claimed in addition to the primary procedure.
When to Use
- Use E969 strictly as an add-on when performing a submucous resection of the nasal septum during the same operative session as a LeFort I osteotomy (R580) for cleft palate correction.
- Apply this code when the clinical documentation confirms that the SMR was a distinct, necessary component of the cleft palate surgical plan alongside the primary osteotomy.
Common Pitfalls
- Billing E969 as a standalone procedure will result in automatic rejection, as it is strictly an add-on code requiring R580 on the same claim.
- Attempting to bill E969 for routine septal work that is already considered integral to the primary R580 procedure without specific documentation of the submucous resection will lead to audit recovery.
Billing Tips
- Ensure the primary procedure R580 is listed first on the claim to trigger the correct processing of the E969 add-on fee.
- Verify that the age-specific premiums (e.g., under 16 years) are applied to both the primary R580 and the add-on E969 to maximize the total procedural reimbursement.
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