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N538
N538 – Repair of myelomeningocoele (two surgeons) - reconstructive surgeon
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
This code is for the service rendered by a reconstructive surgeon as part of a two-surgeon team for the repair of a myelomeningocoele. The neurosurgeon's component of the procedure is billed separately under the fee code N537.
When to Use
- Use this code specifically when acting as the reconstructive surgeon performing skin closure or tissue rearrangement in a two-surgeon team alongside a neurosurgeon billing N537.
- Apply this code when the complexity of the myelomeningocoele repair necessitates a formal two-surgeon approach for the reconstructive component, distinct from the primary neurosurgical closure.
Common Pitfalls
- Billing N538 in conjunction with any decompressive spinal codes, which will trigger an automatic rejection based on the explicit restriction in the Schedule of Benefits.
- Failing to ensure the neurosurgeon has billed N537, as the Ministry may audit the claim for evidence of the two-surgeon team requirement.
Billing Tips
- Always verify the patient's exact age at the time of surgery to apply the appropriate age-based premium (e.g., the 30% premium for neonates under 30 days), as this significantly increases the base fee of $881.55.
Provider Fee$881.55
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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