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N537
N537 – Repair of myelomeningocoele (two surgeons) - neurosurgeon
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
This service represents the neurosurgical portion of a two-surgeon repair of a myelomeningocoele. It includes the neurosurgeon's work in the procedure. The reconstructive surgeon's work is billed separately under N538. Per the Schedule, decompressive codes are not eligible for payment with this service, but fusion procedures are. This service is for the neurosurgeon.
When to Use
- Use N537 exclusively for the neurosurgical component of a two-surgeon myelomeningocoele repair where the neurosurgeon is performing the neural element closure.
- Use this code when the procedure is performed in conjunction with a reconstructive surgeon, who must bill their portion separately using N538.
Common Pitfalls
- Billing any decompressive procedure code on the same claim will result in an automatic rejection, as these are explicitly excluded from payment with N537.
- Failure to coordinate with the reconstructive surgeon can lead to audit flags if the billing records for N537 and N538 do not align regarding the patient and date of service.
Billing Tips
- Ensure the claim includes the appropriate age premium (e.g., AGE_PREMIUM_LT30D) if the patient is under 30 days old, as this is a common and significant value-add for this procedure.
- If a spinal fusion is performed during the same operative session, ensure it is billed as a separate, eligible procedure alongside N537, as fusion is permitted while decompression is not.
Provider Fee$510.00
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
Neurological Surgical Procedures, Spinal Surgical Procedures
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