N523 – AV malformation of cord - excision/obliteration
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the excision or obliteration of an arteriovenous (AV) malformation of the spinal cord. This procedure is eligible for payment to the surgeon (suffix A), a surgical assistant (suffix B), and an anaesthesiologist (suffix C). The assistant's fee is calculated based on 10 basic units plus time units. The anaesthesiologist's fee is calculated based on 13 basic units plus time units. Note: No other decompressive codes are eligible for payment when rendered with N523. This service may be eligible for add-on premiums such as the acute spinal cord injury premium (E383), trauma premium (E420), and various age-based and after-hours premiums.
When to Use
- Use N523 for the definitive surgical excision or obliteration of a spinal cord arteriovenous malformation.
- Select this code when the primary surgical intent is the management of the vascular lesion itself, rather than a general spinal decompression.
Common Pitfalls
- Billing for additional spinal decompression procedures concurrently with N523 will result in automatic rejection due to the explicit restriction on decompressive codes.
- Failing to append the appropriate suffix (A for surgeon, B for assistant, C for anaesthesiologist) will cause the claim to fail processing.
- Omitting eligible add-on premiums like E383 for acute spinal cord injury or E420 for trauma when the clinical criteria are met results in significant under-billing.
Billing Tips
- Ensure that any applicable anaesthesia extra units (e.g., E007C, E010C, or E022C) are submitted alongside the N523C base fee to capture the full complexity of the procedure.
- Verify that no other spinal surgery codes are submitted on the same day if they fall under the 'decompressive' category, as N523 is considered an all-inclusive procedure for the site.
Effective: April 1, 2025
Z. Spinal Surgical Procedures
SPINAL SURGICAL PROCEDURES
Surgical
Spinal Surgical Procedures
No other decompressive codes are eligible for payment when rendered with N523.
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