N529 – Medullary spinal trigeminal tractotomy
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
Medullary spinal trigeminal tractotomy is a surgical procedure listed under Spinal Surgical Procedures. Payment for the surgeon (suffix A) is a flat fee. Payment for surgical assistant (suffix B) and anaesthesiologist (suffix C) services are calculated using base units plus time-based units. The service has 10 base units assigned for the assistant and 15 base units for anaesthesia. An additional premium, E383, is payable to the surgeon for acute spinal cord injury cases. No decompressive codes are eligible for payment when rendered with N529.
When to Use
- Use N529 for the surgical performance of a medullary spinal trigeminal tractotomy, ensuring no decompressive procedure codes are billed on the same claim.
- Apply the E383 premium specifically when the tractotomy is performed in the context of an acute spinal cord injury.
Common Pitfalls
- Billing any decompressive surgical codes concurrently with N529 will result in automatic rejection or audit recovery, as these are explicitly restricted.
- Failure to document the Injury Severity Score (ISS) or the specific clinical criteria for acute spinal cord injury when claiming the E383 premium is a frequent cause of audit adjustments.
Billing Tips
- Ensure the E383 premium is submitted on the same claim as the N529 procedure to maintain eligibility for the acute spinal cord injury supplement.
- Verify that no other restricted neurological surgical procedures are included in the claim, as N529 has strict exclusivity rules regarding concurrent spinal surgical billing.
Effective: April 1, 2025
Z. Spinal Surgical Procedures
SPINAL SURGICAL PROCEDURES
Surgical
Spinal Surgical Procedures
All insured services must be documented in appropriate records that establish: an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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