N218 – Extracranial-intracranial microvascular anastomosis superficial temporal artery
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
Extracranial-intracranial microvascular anastomosis involving the superficial temporal artery. This is a surgical revascularization procedure performed to restore or augment blood flow to the brain, often in cases of arterial occlusion or Moyamoya disease. The service includes the full surgical procedure as performed by the primary surgeon.
When to Use
- Use N218 for direct superficial temporal artery to middle cerebral artery (STA-MCA) bypass procedures performed to treat symptomatic intracranial arterial occlusive disease.
- Use N218 for revascularization in patients with Moyamoya disease where an extracranial-intracranial bypass is required to restore cerebral perfusion.
Common Pitfalls
- Failing to append the E904 add-on code when the anastomosis is specifically performed in the posterior fossa, which results in an underpayment of $241.00.
- Neglecting to document the Injury Severity Score (ISS) in the operative report when attempting to claim the E420 trauma premium, leading to automatic rejection of the 50% increase.
- Incorrectly billing N218 for simple arterial repairs or non-microvascular procedures that should be coded under standard vascular or neurosurgical codes like N106 or N121.
Billing Tips
- Always ensure the operative report explicitly details the microvascular nature of the anastomosis to support the N218 claim during potential post-payment audits.
- When billing for surgical assistance or anesthesia, use the specific N218B and N218C codes respectively to ensure the correct 15-unit base is applied to your claim.
Effective: April 1, 2025
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Neurological Surgical Procedures
All insured services must be documented in appropriate records to establish that the service was provided, medically necessary, and is the service for which the account is submitted, as per the Act requirements detailed in Appendix G of the Schedule. For surgical procedures, this includes an appropriate operative report. (:22)
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