N128 – Repair of encephalocoele
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
Repair of encephalocoele. This is a surgical procedure listed in the Neurological Surgical Procedures section of the Schedule of Benefits. The fee for the surgeon (suffix A) is a flat rate. The fees for the assistant (suffix B) and anaesthetist (suffix C) are calculated based on basic units plus time units. In addition to the <common elements> of all insured services, this service includes the <specific elements> of surgical and anaesthesia services as outlined in the Schedule of Benefits (see , ).
When to Use
- Use N128 for the definitive surgical repair of an encephalocoele, typically performed in a neurosurgical setting.
- Select N128 when the procedure involves the reduction of the herniated neural tissue and the repair of the cranial defect, distinguishing it from simpler diagnostic or exploratory procedures.
Common Pitfalls
- Billing N128 with a second assistant without prior authorization from a medical consultant, as it is not on the pre-approved list for dual surgical assistance.
- Incorrectly billing basic units for an assistant or anaesthetist when multiple procedures are performed; only the basic units for the major procedure (N128) are eligible.
Billing Tips
- Ensure the appropriate age-based premium (e.g., AGE_PREMIUM_UNDER_30_DAYS) is applied to the surgeon, assistant, and anaesthetist fees, as these are highly relevant for pediatric encephalocoele repairs.
- When performing N128 as a non-elective procedure after hours, ensure the start time is clearly documented to support the application of E409 or E410 premiums.
Effective: April 1, 2025
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Neurological Surgical Procedures
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