N556 – First site
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
This service is for a percutaneous vertebral facet medial branch or sacral lateral branch neurotomy. This billing code represents the service for the first site treated. For each additional site treated during the same session, use the add-on code E396. This service is marked with a '#' prefix on page , indicating that facility costs (premises, equipment, supplies, personnel) are not included in the fee when performed in a hospital or an Integrated Community Health Services Centre (ICHSC) as per .
When to Use
- Use N556 as the primary code for the first percutaneous vertebral facet medial branch or sacral lateral branch neurotomy performed during a session.
- Use N556 in conjunction with E396 when treating multiple sites, ensuring N556 is billed for the first site and E396 for each subsequent site.
Common Pitfalls
- Billing N556 multiple times for additional sites instead of using the required add-on code E396 will result in claim rejection or audit recovery.
- Attempting to bill for facility, equipment, or supply costs when performing N556 in a hospital or ICHSC is prohibited due to the '#' prefix designation.
- Failing to obtain prior authorization for surgical assistant services (M400B) when the assistant's presence is required for this procedure.
Billing Tips
- Ensure the surgical assistant units are calculated based on the anaesthesia unit value of 6, as N556 does not have a specific assistant unit value listed.
- Always document the specific anatomical sites treated to justify the quantity of E396 add-on codes submitted alongside N556.
Effective: April 1, 2025
Z. Spinal Surgical Procedures
SPINAL SURGICAL PROCEDURES
Surgical
Spinal Surgical Procedures, Diagnostic and Therapeutic Procedures
This service is denoted by the '#' prefix. When performed in a hospital or an Integrated Community Health Services Centre (ICHSC), the premises, equipment, supplies, and personnel used to perform all elements of the service are funded by the hospital global budget or ICHSC funding respectively. Patients cannot be charged for these items in these settings.
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