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N104
N104 – Craniotomy plus removal - supratentorial
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
This service code represents a craniotomy followed by the removal of a spontaneous intracerebral hemorrhage located in the supratentorial region. This is a major neurological surgical procedure and is eligible for surgeon (A), assistant (B), and anaesthetist (C) fees. Assistant and anaesthetist fees are calculated based on base units plus time units.
When to Use
- Use N104 for the surgical evacuation of a spontaneous supratentorial intracerebral hemorrhage via craniotomy.
- Select N104 when the primary surgical intent is the removal of a hematoma, distinguishing it from N157 which is typically reserved for tumor resections or other non-hemorrhagic intracranial pathology.
Common Pitfalls
- Billing N104 in conjunction with other intracranial procedures without clear documentation of separate surgical sites or distinct pathologies, which risks a rejection for unbundling.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, which is a common cause for post-payment audit recovery.
- Incorrectly applying after-hours premiums (E409/E410) for elective cases that were not delayed by an intervening surgical emergency.
Billing Tips
- Ensure the operative report explicitly details the supratentorial location and the evacuation of the hemorrhage to support the N104 code against potential audit queries.
- When claiming the E420 trauma premium, ensure the ISS score is clearly recorded in the patient chart, as this is a mandatory requirement for the 50% increase.
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