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N535
N535 – Repair of meningocoele
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the repair of a meningocoele. This procedure is listed under Spinal Surgical Procedures in the OHIP Schedule of Benefits. See for details.
When to Use
- Use N535 for the primary surgical repair of a meningocoele when no spinal decompression is performed during the same operative session.
- Use N535 for the repair of a congenital meningocoele in pediatric patients, ensuring the age-based premium is applied if the patient is under 16 years of age.
Common Pitfalls
- Billing any decompressive procedure code alongside N535 will result in an automatic rejection, as these are explicitly restricted by the Schedule of Benefits.
- Failure to document the Injury Severity Score (ISS) in the medical record when attempting to claim the E420 trauma premium for this procedure will lead to audit recovery.
Billing Tips
- You may bill fusion procedures in addition to N535 if they are clinically necessary and performed during the same operative session.
- Always verify the patient's exact age in days or years at the time of the procedure to ensure the correct age-based premium (e.g., AGE_PREMIUM_LT30D through AGE_PREMIUM_LT16Y) is applied to the $510.00 base fee.
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