N113 – Craniotomy for brain biopsy (other than for tumour)
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving the creation of an opening in the skull (craniotomy) to perform a biopsy of brain tissue for reasons other than a suspected tumour. The listed fee is for the surgeon's component (N113A). Assistant (N113B) and anaesthesia (N113C) services are compensated separately based on a system of basic units and time units. As per the Schedule (), this service is assigned 11 basic units for an assistant and 11 basic units for anaesthesia.
When to Use
- Use N113 for a craniotomy performed specifically to obtain a brain tissue biopsy when a tumour is not the suspected diagnosis, such as for suspected inflammatory, infectious, or autoimmune conditions.
- Do not use N113 for tumour-related biopsies; those procedures fall under different neurological surgical codes (e.g., N115 or N117 series) depending on the specific location and nature of the lesion.
Common Pitfalls
- Billing N113 for a biopsy where a tumour was the primary suspicion will lead to audit scrutiny; ensure the operative report clearly justifies the non-tumour indication.
- Incorrectly applying after-hours premiums (E409/E410) to elective cases; these premiums are strictly reserved for non-elective procedures or elective cases delayed by an intervening surgical emergency.
Billing Tips
- Always verify the Injury Severity Score (ISS) and document it in the medical record if attempting to claim the E420 trauma premium, as this is a mandatory requirement for audit compliance.
- Ensure the anaesthesiologist and assistant codes (N113B/N113C) are billed separately using the 11 basic units assigned to this procedure to avoid under-remuneration.
Effective: April 1, 2025
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Neurological Surgical Procedures
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