N267 – Occipital and/or suboccipital craniectomy for compression, decompression or section of cranial nerves
OHIP Otolaryngology Code — NEUROLOGICAL SURGICAL PROCEDURES · Schedule of Benefits
Surgical procedure from the Musculoskeletal System section of the Schedule of Benefits. As a surgical procedure, payment is subject to the general rules outlined in the Schedule of Benefits. Constituent Elements: As per , , this service includes all common elements such as arranging appointments, obtaining history, maintaining records, and providing prescriptions. Specific surgical elements are detailed in the preamble to the surgical section of the Schedule. Post-operative care is generally included in the fee for the surgical procedure. Suffixes: The following suffixes apply as per : - A: for the physician performing the procedure. - B: for the physician assisting at the surgery. - C: for the physician administering the anaesthetic. Assistant and Anaesthesia Fees: Fees for assistants (suffix B) and anaesthetists (suffix C) are calculated based on a combination of basic units and time units, as detailed in - (Surgical Assistants) and - (Anaesthesiologists). Premiums: This service may be eligible for various premiums, including: - Age-Based Premiums: For patients under 16 years of age, as per . - After Hours Premiums: For non-elective procedures or delayed elective procedures commencing after hours, as per . Different premiums apply to the surgeon (E409, E410), assistant (E400B, E401B), and anaesthetist (E400C, E401C). - Trauma Premium: E420 may be payable if the service is for a trauma patient meeting specific Injury Severity Score (ISS) criteria, as per . Medical Records: All services must be properly documented in the patient's medical record, including operative reports and anaesthesia records, as per .
When to Use
- Use N267 for microvascular decompression of the trigeminal nerve or other cranial nerves when a suboccipital craniectomy is the primary approach.
- Use N267 for surgical decompression of the posterior fossa structures when the procedure specifically involves the craniectomy for cranial nerve access.
Common Pitfalls
- Failing to bill E901 concurrently when an operating microscope is used, as it is a distinct add-on fee specifically linked to N267.
- Attempting to bill a second assistant without prior authorization, as N267 is not on the pre-approved list for multiple assistants.
Billing Tips
- Always ensure E901 is included on the same claim as N267 to capture the additional $252.40 for the use of the operating microscope.
- If performing multiple procedures under the same anaesthetic, remember that assistant and anaesthesia basic units are restricted to the major procedure only.
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, establishing that an insured service was provided, the service claimed was the service rendered, and the service was medically necessary. Source:
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