What is OHIP billing code N246?

N246 is "Removal of shunt - any type", an OHIP Otolaryngology code from the Ontario Schedule of Benefits (Physician Services).

How much does N246 pay?

The current OHIP fee for N246 is $289.70, effective 2025-04-01, per the Ontario Schedule of Benefits.

How do I bill N246 to OHIP?

N246 is submitted through OHIP's MCEDT claims system, either directly or via billing software. SnapBill validates N246 claims against the Schedule of Benefits rules before submission.

All codes

N246

N246 – Removal of shunt - any type

OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits

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Removal of shunt - any type. This code is for a surgical procedure and is eligible for surgeon (A), assistant (B), and anaesthetist (C) fees. General rules for surgical procedures, including after-hours and age-based premiums, apply as outlined in the General Preamble.

When to Use

Use N246 for the complete removal of a malfunctioning or infected ventricular shunt system, including the ventricular catheter and distal tubing.
Use N246 when a shunt is removed as a standalone procedure, as it is distinct from the insertion or revision codes (e.g., N174).
Use N246 when converting a patient to an external ventricular drain (EVD) if the primary intent and procedure is the removal of the existing shunt hardware.

Common Pitfalls

Billing N246 in conjunction with N174 (shunt insertion/revision) is a common error; N246 is intended for removal only, and bundling rules often restrict claiming both unless specific criteria are met.
Failure to document the specific type of shunt removed or the clinical indication for removal (e.g., infection, mechanical failure) can lead to audit scrutiny.
Incorrectly applying after-hours premiums (E409/E410) to elective removals; these premiums are strictly reserved for non-elective procedures or those delayed by surgical emergencies.

Billing Tips

Ensure that if an EVD is placed during the same operative session as the shunt removal, you verify if the EVD placement is considered a separate billable procedure or an inclusive component of the removal.
Always confirm the patient's age at the time of the procedure to ensure the appropriate age-based surgical premium (e.g., AGE_PREMIUM_LT30D) is appended to the claim.

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Provider Fee$289.70

Surgical Assistant Fee$87.57

Anaesthetist Fee$108.43

Non-Anaesthetist Fee$108.43

Effective: April 1, 2025

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