N223 – Vertebral endarterectomy
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
Vertebral endarterectomy is a neurological surgical procedure. The fee for the surgeon is claimed with suffix A. The service is eligible for surgical assistant (suffix B) and anaesthetist (suffix C) services. The amount payable for the surgical assistant service is calculated based on 10 basic units (Asst) plus time units. The amount payable for the anaesthesia service is calculated based on 10 basic units (Anae) plus time units. For rules on unit calculation, refer to the General Preamble (- for assistants and - for anaesthetists).
When to Use
- Use N223 specifically for vertebral artery endarterectomy; do not use this code for carotid endarterectomy, which is billed under R792.
- Use this code for the primary surgical procedure performed by the neurosurgeon when the vertebral artery is the target of the endarterectomy.
Common Pitfalls
- Billing N223 for a carotid endarterectomy is a common error; ensure the surgical site is correctly identified as vertebral to avoid rejection or audit recovery.
- Failing to document the specific start and end times for the surgical assistant and anaesthetist will lead to rejected claims for the time-based unit portions of the fee.
- Attempting to bill a second surgical assistant without prior authorization or a supporting letter of necessity will result in automatic denial of the second assistant's claim.
Billing Tips
- When performing multiple procedures during the same session, ensure N223 is identified as the major procedure to correctly anchor the basic unit calculation for the assistant and anaesthetist.
- Always verify if the case qualifies for E400B/E401B (assistant) or E400C/E401C (anaesthetist) based on the exact start time of the procedure to maximize the after-hours premium eligibility.
Effective: April 1, 2025
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Neurological Surgical Procedures
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