N149 – Removal of foreign body from brain
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
N149 represents a surgical procedure within the Neurological Surgical Procedures (X) section of the OHIP Schedule of Benefits. The fee listed is for the primary surgeon (suffix A). The service includes pre-operative, intra-operative, and post-operative care as defined in the Schedule. Services for a surgical assistant (suffix B) and an anaesthesiologist (suffix C) are billed separately and calculated based on a system of basic units plus time units as outlined in the General Preamble. Specific details regarding this procedure are found in the Neurological Surgical Procedures (X) section of the Schedule of Benefits.
When to Use
- Use N149 for the definitive surgical removal of a foreign body located within the brain parenchyma or ventricles.
- Use N149 when the procedure is performed as a primary surgical intervention, distinct from simple wound debridement or superficial scalp foreign body removal which may fall under different procedural codes.
Common Pitfalls
- Billing N149 for the removal of a foreign body that is strictly extracranial or limited to the skull/scalp; ensure the operative report clearly documents intracranial involvement.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, which is a frequent cause of audit recovery for neurosurgical procedures.
- Incorrectly billing N149 alongside other neurosurgical procedures without checking for 'major procedure' rules, which may result in the denial of the secondary procedure's basic units for the assistant and anaesthesiologist.
Billing Tips
- Ensure the operative report explicitly details the intracranial location of the foreign body to support the N149 claim against potential post-payment review.
- When multiple surgical procedures are performed during the same anaesthetic, remember that only the major procedure's basic units are payable for the surgical assistant and anaesthesiologist.
Effective: April 1, 2025
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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