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N536
N536 – Repair of myelomeningocoele (one surgeon)
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
Repair of myelomeningocoele (one surgeon). This is a major spinal surgical procedure. The fee for the surgical assistant is based on 7 base units plus time units. The fee for the anaesthesiologist is based on 9 base units plus time units. See the unitBasedInfo and billingInteractions sections for detailed calculation rules and applicable premiums.
When to Use
- Use N536 for the primary surgical repair of a myelomeningocoele when performed by a single surgeon.
- Use this code for the definitive closure of the spinal defect, as it is specifically designated for this major spinal procedure.
Common Pitfalls
- Attempting to bill any decompressive surgical codes alongside N536 will result in automatic rejection, as they are explicitly restricted.
- Failing to apply the correct age-based percentage premium to the surgical fee for pediatric patients, which varies significantly based on the specific age brackets defined in the SOO.
- Incorrectly applying anaesthesia unit codes; ensure you use the specific 'E' codes (e.g., E021C, E009C, E019C) rather than attempting to apply the surgical age premium to the anaesthesiologist's fee.
Billing Tips
- Always verify the Injury Severity Score (ISS) is documented in the chart if claiming the E420 trauma premium, as this is a mandatory audit requirement.
- When performing a fusion procedure in the same session, ensure it is billed as a separate eligible code, as it is permitted alongside N536.
Provider Fee$1,217.10
Surgical Assistant Fee$87.57
Anaesthetist Fee$139.41
Non-Anaesthetist Fee$139.41
Effective: April 1, 2025
Category
Z. Spinal Surgical Procedures
Subcategory
SPINAL SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Spinal Surgical Procedures
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