N165 – Lateral canthal advancement - two surgeons, major portion
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
Represents a surgical procedure for lateral canthal advancement, performed by two surgeons (major portion), listed within the Neurological Surgical Procedures section of the Schedule of Benefits. The service includes the surgical procedure itself (suffix A), as well as unit-based fees for surgical assistance (suffix B) and anaesthesia (suffix C). It is subject to general rules for surgery, including age-based premiums, after-hours premiums, and the trauma premium.
When to Use
- Use N165 when performing a lateral canthal advancement as part of a multi-surgeon team where you are designated as the lead surgeon for the major portion of the procedure.
- Use this code specifically for neurological or complex craniofacial reconstructive cases involving lateral canthal positioning that require the expertise of two surgeons.
Common Pitfalls
- Billing N165 without clear documentation of the 'two-surgeon' requirement or the specific division of labor, which can lead to audit scrutiny.
- Attempting to claim a hospital admission assessment alongside N165, which is disallowed unless it qualifies as the 'major pre-operative visit' where the decision to operate was finalized.
Billing Tips
- Ensure the operative report explicitly details the involvement of the second surgeon and the specific components of the procedure that constitute the 'major portion' to justify the N165 claim.
- If the procedure is performed on a trauma patient, ensure the Injury Severity Score (ISS) is documented in the chart to support the addition of the E420 trauma premium.
Effective: April 1, 2025
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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