E971 – LeFort I cleft palate - with closure alveolar fistula with or without bone graft
OHIP Surgical Assists Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This is an add-on surgical procedure performed in conjunction with a LeFort I osteotomy for cleft palate (e.g., R580). The service involves the closure of an alveolar fistula, which can be performed with or without the use of a bone graft. The fee for this service is paid in addition to the primary surgical procedure. The note on page indicates that harvesting and grafting of bone or cartilage grafts is included in the fee for the primary procedures marked with an asterisk, which are in the same surgical category.
When to Use
- Use E971 as an add-on code specifically when closing an alveolar fistula during the same operative session as a LeFort I osteotomy (e.g., R580).
- Apply this code regardless of whether a bone graft is utilized, as the fee structure covers the closure procedure in both scenarios.
Common Pitfalls
- Attempting to bill E971 as a standalone procedure will result in rejection; it must be linked to a primary LeFort I osteotomy code.
- Failing to document the specific presence and closure of the alveolar fistula in the operative report is a common audit risk, as the primary procedure (R580) does not inherently cover this specific repair.
Billing Tips
- Ensure the primary procedure (e.g., R580) is billed on the same claim to trigger the add-on eligibility for E971.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Procedure
Musculoskeletal System Surgical Procedures
Standard operative report detailing the procedure performed.
As per , the medical record must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.
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