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N543
N543 – Sympathectomy - unilateral - cervico-dorsal
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
Unilateral cervico-dorsal sympathectomy. This surgical procedure fee is for the surgeon's service (suffix 'A') and includes the necessary pre-operative and post-operative care associated with the surgery. The services of a surgical assistant (suffix 'B') and an anaesthesiologist (suffix 'C') are also insured and are calculated based on basic units plus time-based units. See - for surgical assistant rules and - for anaesthesiologist rules.
When to Use
- Use N543 for a unilateral cervico-dorsal sympathectomy when the procedure is performed as a primary surgical intervention.
- Select N543 over N542 if the surgical approach specifically targets the cervico-dorsal region unilaterally, ensuring the site matches the operative report.
Common Pitfalls
- Billing N543 bilaterally is a common error; if both sides are performed, you must use the appropriate bilateral code or modifier as defined in the Schedule of Benefits, as N543 is strictly unilateral.
- Failure to document the specific surgical approach can lead to audit rejections, as N543 is a specific procedure code that does not encompass broader neurosurgical explorations.
Billing Tips
- Ensure that the surgical assistant and anaesthesiologist claims are linked to the same procedure date and patient to avoid rejection of their respective time-based unit claims.
- If the procedure is performed on an emergency basis after hours, ensure the correct after-hours premium (E409 or E410) is appended to the N543 claim to capture the 50% or 75% procedural fee increase.
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