N513 – One disc level - below C2
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
This procedure involves a posterior spinal arthrodesis (fusion) with instrumentation for a single disc level. It is intended to be claimed by a surgeon who is separate from the surgeon performing the primary decompression or osteotomy. This service can be performed in the cervical spine (below ), thoracic spine, or lumbar spine. Additional levels or specific junctions can be added using codes such as E366, E371, E377, or E387. The corresponding code for when the same surgeon performs both the primary procedure and the fusion is E370.
When to Use
- Use N513 when you are the secondary surgeon performing posterior spinal arthrodesis with instrumentation at a single level below C2, distinct from the surgeon performing the primary decompression.
- Use N513 for thoracic or lumbar spinal fusion when your role is limited to the instrumentation/fusion component of the procedure.
Common Pitfalls
- Do not bill N513 if you are the same surgeon performing the primary decompression or osteotomy; use E370 instead.
- Avoid claiming E372 or E376 for morselized bone graft alone, as these codes require the insertion of a cage or structural bone graft.
- N513 will be automatically reduced to E366 if billed in conjunction with N528, as the system treats the combination as an add-on scenario.
Billing Tips
- Ensure you append the correct add-on codes (E366, E371, E377, or E387) for additional levels or specific junctions to maximize the claim value beyond the base N513 fee.
- If performing a posterior interbody implant or graft, ensure you claim E372 for the first level and E376 for any subsequent levels to capture the stabilization component.
Effective: April 1, 2025
Z. Spinal Surgical Procedures
SPINAL SURGICAL PROCEDURES
Surgical
Spinal Surgical Procedures
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