N167 – Lateral canthal advancement - bilateral - one surgeon
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
This surgical service covers the procedure of lateral canthal advancement, performed bilaterally by one surgeon. As a surgical procedure listed in the Schedule, general payment rules for surgery, surgical assistance, and anaesthesia apply. The fee for the primary surgeon is claimed with suffix A. Fees for surgical assistance (suffix B) and anaesthesia (suffix C) are calculated based on basic and time units as outlined in the General Preamble.
When to Use
- Use N167 for bilateral lateral canthal advancement procedures performed by a single surgeon; do not bill as two separate unilateral procedures.
- Use this code for surgical correction of lateral canthal dystopia or related orbital musculoskeletal conditions requiring bilateral advancement.
Common Pitfalls
- Billing N167 alongside other orbital or eyelid procedures without verifying if the other codes are considered inclusive of the lateral canthal advancement.
- Attempting to bill N167 as two separate unilateral procedures; the code is specifically defined as bilateral and the fee reflects this.
- Failing to document the specific surgical approach or the bilateral nature of the procedure, which can lead to audit scrutiny regarding the necessity of the bilateral service.
Billing Tips
- Ensure the claim includes the 'A' suffix for the primary surgeon to trigger the correct fee payment.
- If the patient is under 16 years of age, verify the correct age-based premium is applied to the N167 fee to maximize the claim value.
Effective: April 1, 2025
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
When an anaesthetic has begun but the operation is cancelled prior to commencement of surgery, the service for the anaesthesiologist constitutes E006C with the actual number of time units added to 6 basic units for this service. ()
When an anaesthetic has begun but the operation is cancelled prior to commencement of surgery and the assistant has scrubbed but is not required to do anything further, the service is payable as E006B with the actual number of time units added to 6 basic units for this service. ()
If a procedure is cancelled prior to induction of anaesthesia, the service constitutes a subsequent hospital visit for both the surgeon and anaesthesiologist. (, )
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