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N519
N519 – C1/C2 fusion using graft/posterior wires
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
A posterior spinal arthrodesis performed as a sole procedure. N519 is specifically for a cervical / fusion using graft and posterior wires, performed without instrumentation.
When to Use
- Use N519 for a posterior C1/C2 arthrodesis utilizing bone graft and posterior wiring techniques as the primary procedure.
- Select N519 when performing a C1/C2 fusion without the use of instrumentation such as screws or plates.
Common Pitfalls
- Billing N514 alongside N519 will trigger an automatic reduction of the N514 fee to the E364 rate, resulting in significant underpayment.
- Attempting to bill N519 with other fusion procedures at the same level will result in a claim rejection, as it is restricted to sole-procedure status for that level.
- Failure to document the absence of instrumentation can lead to audit scrutiny, as N519 is specifically defined as a non-instrumented procedure.
Billing Tips
- If additional disc levels are fused beyond the C1/C2 level during the same operative session, append E364 for each additional level to maximize the claim.
- Ensure the operative report explicitly details the use of graft and posterior wiring to support the N519 code selection over instrumented alternatives.
Provider Fee$612.00
Surgical Assistant Fee$100.08
Anaesthetist Fee$154.90
Non-Anaesthetist Fee$154.90
Effective: April 1, 2025
Category
Z. Spinal Surgical Procedures
Subcategory
SPINAL SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Spinal Surgical Procedures
All insured services must be documented in appropriate records establishing that an insured service was provided, the service submitted is the service rendered, and the service was medically necessary.
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