N249 – Third ventriculostomy
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure, 'Third ventriculostomy', listed under the Neurological Surgical Procedures section, specifically within the CSF Shunting Procedures. This service is subject to the general rules for surgical procedures outlined in the General Preamble. The fee for the surgeon (suffix A) is a flat rate. Fees for the assistant (suffix B) and anaesthetist (suffix C) are calculated based on basic and time units as described in the Surgical Assistants' Services (-) and Anaesthesiologists' Services (-) sections of the Schedule.
When to Use
- Use N249 for an endoscopic third ventriculostomy (ETV) performed to treat obstructive hydrocephalus.
- Use this code when the procedure is the primary surgical intervention, distinct from shunt revision or insertion codes like N247 or N248.
Common Pitfalls
- Do not bill N249 in conjunction with other intracranial shunt procedures unless a separate, distinct surgical incision and site are utilized, as this may trigger a multiple procedure reduction rule.
- Failure to document the specific Injury Severity Score (ISS) in the chart will result in the rejection of the E420 trauma premium even if the patient meets the clinical trauma criteria.
Billing Tips
- Ensure the age-based premium is applied correctly based on the patient's exact age at the time of the procedure, as these are calculated as a percentage of the N249 base fee.
Effective: April 1, 2025
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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