N265 – Differential section facial nerve for hemi-facial spasm (extracranial approach)
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
N265 represents a surgical procedure within the Neurological Surgical Procedures section of the OHIP Schedule of Benefits. The procedure is a differential section of the facial nerve for hemi-facial spasm (extracranial approach). Claims should be submitted with the appropriate suffix: A for the surgeon, B for a surgical assistant, and C for the anaesthesiologist, as per the rules outlined on . The amount payable for assistant and anaesthesia services is calculated by adding basic and time units, as detailed in the General Preamble (- for assistants, - for anaesthesiologists). Various premiums may apply, such as those for age, after-hours services, and trauma.
When to Use
- Use N265 for the surgical management of refractory hemi-facial spasm via an extracranial approach to the facial nerve.
- Select N265 when performing a selective neurectomy or differential sectioning of facial nerve branches to alleviate involuntary facial muscle contractions.
Common Pitfalls
- Do not bill N265 in conjunction with intracranial procedures for hemi-facial spasm, such as microvascular decompression, which fall under different neurological surgical codes.
- Avoid billing N265 as a bilateral procedure without clear documentation of separate incisions or distinct surgical sites, as OHIP may flag it for manual review.
Billing Tips
- Ensure the surgical assistant and anaesthesiologist claims utilize the 6 basic units assigned to N265 when calculating total procedural fees.
Effective: April 1, 2025
X. Neurological Surgical Procedures
NEUROLOGICAL SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records. The Act requires that the record establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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