N549 – Incision and drainage including sequestrectomy, anterior approach
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
This surgical procedure involves an incision, drainage, and sequestrectomy (removal of dead bone) for spinal osteomyelitis, performed via an anterior approach. The fee for this service is for the surgeon's work (suffix A). Separate calculations apply for surgical assistant (suffix B) and anaesthesiologist (suffix C) services, which are based on basic units plus time units.
When to Use
- Use N549 specifically for the anterior surgical approach to spinal osteomyelitis when debridement and sequestrectomy are the primary procedural components.
- Select N549 over N548 when the surgical intent and execution involve the removal of necrotic bone (sequestrectomy) rather than simple drainage alone.
Common Pitfalls
- Billing N549 in conjunction with other spinal decompression codes without ensuring the procedures are distinct and not considered inclusive under the Schedule of Benefits.
- Failure to document the specific anterior approach, which is a mandatory requirement for the validity of the N549 claim.
Billing Tips
- Ensure that if the patient is 65 years of age or older, the 15% age premium is applied to the base fee of $632.40 as per the surgical procedure guidelines.
Effective: April 1, 2025
Z. Spinal Surgical Procedures
SPINAL SURGICAL PROCEDURES
Surgical
Spinal Surgical Procedures
All insured services must be documented in appropriate records establishing that the service was provided, is the service for which the account is submitted, and was medically necessary.
If claiming the E420 trauma premium, the Injury Severity Score (ISS) must be listed in the patient's medical record.
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