M086 – Trans-nasal endoscopic repair of CSF rhinorrhea
OHIP Ophthalmology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Performs a trans-nasal endoscopic repair of a cerebrospinal fluid (CSF) leak. This comprehensive service includes the harvesting of any necessary graft material. The procedure may be performed with or without the aid of a 3D CT/MRI image guided system, the use of which is included in the fee and not billed separately. This service is categorized under Respiratory Surgical Procedures as per page of the Schedule.
When to Use
- Use M086 for the definitive endoscopic repair of a CSF leak, including cases where you must harvest autologous graft material such as fascia lata or turbinate mucosa.
- Use M086 when performing endoscopic closure of a skull base defect, regardless of whether you utilize 3D CT/MRI image-guided navigation during the procedure.
Common Pitfalls
- Do not bill separately for image guidance (e.g., navigation systems), as the fee for M086 explicitly includes the use of 3D CT/MRI image-guided systems.
- Do not bill separately for the harvesting of graft material, as this is considered an integral component of the M086 procedure and is not eligible for additional compensation.
- Avoid billing M086 alongside other endoscopic sinus procedures without applying the 85% reduction rule for multiple procedures performed by the same surgeon under the same anaesthesia.
Billing Tips
- If a surgical assistant is required, you must submit a letter to a medical consultant justifying the necessity of the assistant and bill using code M400B, as there is no pre-assigned assistant unit for M086.
- Ensure that if you perform a subsequent procedure for a new condition during the same hospitalization, you clearly document the distinct nature of the condition to ensure the full benefit is applied rather than the 85% multiple-procedure reduction.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
Payment for M086 includes harvesting of graft material.
The use of a 3D CT/MRI image guided system is included in the fee for M086 and is not separately payable.
Where no basic unit is listed opposite the service in the column headed with 'Asst', the number of basic units is that listed opposite the service under the column headed with 'Anae'. This type of service is only eligible for payment upon authorization by a medical consultant following submission of a letter from the surgeon outlining the reason the assistant was required. Submit claims for this type of service using fee code M400B.
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