N284 – Excision of first rib and/or cervical rib
OHIP Otolaryngology Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This service, listed as N284, covers the excision of the first rib and/or cervical rib, and includes a scalenotomy when performed. It is a surgical procedure and is subject to the general rules for surgery outlined in the Surgical Preamble ( to ). The fee for the surgeon is a flat rate, while the fees for the assistant and anaesthetist are calculated based on basic units plus time units. - Surgeon (A): The fee for the surgeon includes pre-operative and post-operative care as defined in . - Assistant (B): The assistant fee is calculated using 6 basic units plus time units as per . - Anaesthetist (C): The anaesthesia fee is calculated using 6 basic units plus time units as per . Additional extra units may be applicable based on patient factors (e.g., age, ASA status) as described on .
When to Use
- Use N284 for the surgical excision of a first rib or cervical rib, which inherently includes the performance of a scalenotomy.
- Use N284 when performing thoracic outlet decompression surgery where the primary objective is the removal of the rib structure.
Common Pitfalls
- Attempting to bill a separate scalenotomy code in addition to N284; the surgical preamble explicitly states that scalenotomy is included in the N284 fee.
- Failing to apply the 85% rule for multiple procedures if a secondary procedure is performed during the same operative session, as per SP3.
- Incorrectly calculating assistant or anaesthesia units by forgetting to include the mandatory 6 basic units required by GP85 and GP92.
Billing Tips
- Ensure the operative report clearly documents the specific rib excised to justify the N284 code, especially when dealing with anatomical variations like cervical ribs.
- If the procedure is performed after hours, ensure you use the correct premium code (E409 or E410) to increase the procedural fee by the appropriate percentage.
Effective: April 1, 2026
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
Anaesthesia: 6 basic units. See for full anaesthesia rules.
Assistant: 6 basic units. See for full assistant rules.
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