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E970
E970 – LeFort I cleft palate - with pharyngoplasty
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This code is an add-on to be billed with R580 (LeFort I cleft palate in one segment). It represents the additional work of performing a pharyngoplasty during the same operative session.
When to Use
- Use E970 exclusively when a pharyngoplasty is performed concurrently with a LeFort I osteotomy for cleft palate, specifically when the primary procedure is billed as R580.
- This code is the correct add-on when the surgical plan requires both the maxillary advancement (R580) and the secondary pharyngeal flap or sphincter pharyngoplasty to address velopharyngeal insufficiency.
Common Pitfalls
- Billing E970 as a standalone procedure will result in an automatic rejection, as it is strictly an add-on code dependent on the submission of R580.
- Attempting to bill E970 with other LeFort-related codes outside of the R580 category will lead to claim denial, as it is specifically restricted to the R580 base procedure.
Billing Tips
- Ensure that age-based premiums are calculated based on the patient's age at the time of the procedure, as these apply to the combined surgical fee of R580 and E970.
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