N114 – Transsphenoidal endonasal endoscopic resection of pituitary lesion(s)
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
Transsphenoidal endonasal endoscopic resection of lesion(s) originating in the sella turcica requiring simple closure, repair and/or reconstruction of surgical defect(s). This is the fee payable to the surgeon rendering the resection. When performed by the same surgeon, this service may include the endonasal endoscopic or microscopic approach for surgical access to the sella turcica, which itself includes middle turbinate reductions, maxillary antrostomies, ethmoidotomies, ethmoidectomies, sphenoidotomies, septotomy, septoplasty and septal mucosal flap(s) harvest associated with septotomy or sphenoidal mucosal flap(s) when claimed with the add-on code E905.
When to Use
- Use N114 for the primary resection of a pituitary lesion via a transsphenoidal endonasal endoscopic approach when simple closure or reconstruction of the defect is required.
- Use N114 in conjunction with E905 when the surgical access involves extensive nasal work such as septal mucosal flap harvest, middle turbinate reduction, or ethmoidectomy.
- Use N114 with E887 when the pituitary lesion demonstrates suprasellar or parasellar extension specifically involving the optic nerves, optic chiasm, or hypothalamus.
Common Pitfalls
- Attempting to bill separate codes from the Respiratory or Integumentary Surgical Procedures sections for nasal access steps; these are strictly inclusive in N114 and E905.
- Failing to document the specific anatomical area (e.g., clivus or anterior skull base) when claiming E886, which is required for each distinct area accessed beyond the sella.
- Claiming E905 as a standalone procedure; it is a mandatory add-on to the base procedure and cannot be billed independently.
Billing Tips
- Ensure E886 is claimed for each distinct anatomical area accessed if the procedure extends beyond the sella, as it is payable per area.
- Always verify that the surgical report explicitly details the extent of the lesion and the specific reconstruction techniques used to support the use of N114 and any applicable add-on codes.
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