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E972
E972 – LeFort I cleft palate - with closure hard palate 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 (R580A). It involves the specific closure of a fistula in the hard palate. The procedure may or may not include the use of a bone graft. This fee is paid in addition to the fee for the primary R580A procedure.
When to Use
- Use E972 when a hard palate fistula is specifically identified and closed during the same operative session as a LeFort I osteotomy (R580A).
- Apply this code when the fistula closure requires the use of a bone graft, as the graft is explicitly included in the E972 fee structure.
Common Pitfalls
- Submitting E972 without the primary R580A code will result in an automatic rejection, as it is strictly an add-on procedure.
- Attempting to bill E972 for soft palate fistula repairs or other palatal procedures not involving the hard palate will lead to audit discrepancies.
Billing Tips
- Ensure the operative report clearly details the location of the fistula in the hard palate and the use of any bone grafting material to support the E972 claim.
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