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N212
N212 – Orbital decompression
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
Craniotomy plus orbital decompression (roof of orbit with or without lateral wall). This is a surgical procedure performed under the Neurological Surgical Procedures category. Claims can be submitted with suffix 'A' for the surgeon, 'B' for an assistant, and 'C' for the anaesthetist. Assistant services are calculated with 15 base units. Anaesthesia services are calculated with 15 base units. See the unit-based information and add-on codes for detailed fee calculations.
When to Use
- Use N212 specifically for craniotomy-based orbital decompression involving the roof of the orbit, with or without the lateral wall.
- Select N212 when the surgical approach requires a craniotomy, distinguishing it from trans-nasal or trans-antral approaches that would fall under different surgical categories.
Common Pitfalls
- Attempting to bill E901 for the use of an operating microscope with N212 will result in an automatic rejection as it is explicitly restricted.
- Failing to document the specific involvement of the orbital roof or lateral wall can lead to audit scrutiny if the procedure is challenged as a less complex orbital exploration.
Billing Tips
- Ensure that if you are performing multiple procedures during the same anaesthetic, you identify N212 as the major procedure to correctly establish the base units for the assistant and anaesthetist.
- If the procedure is performed on a trauma patient, ensure the Injury Severity Score (ISS) is clearly documented in the chart to support the E420 trauma premium, as this cannot be combined with after-hours premiums.
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