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N559
N559 – Anterior spinal arthrodesis with instrumentation without decompression - Lumbar - One disc level
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
Anterior spinal arthrodesis with instrumentation without decompression involving one lumbar disc level. The fee for this service includes the necessary laparotomy/retroperitoneal approach. Use add-on code E366 for each additional disc level fused. Use add-on code E362 for a combined thoracotomy/laparotomy approach.
When to Use
- Use N559 for a primary anterior lumbar interbody fusion (ALIF) involving a single disc level where instrumentation is placed and no decompression is performed.
- Use N559 when the surgical approach is exclusively anterior (laparotomy or retroperitoneal) and the procedure is limited to a single level.
Common Pitfalls
- Billing N559 alongside decompression codes is a common audit trigger, as N559 explicitly excludes decompression; use appropriate codes from the N-section if decompression is performed.
- Attempting to bill for the surgical approach separately is incorrect, as the fee for N559 is all-inclusive of the laparotomy or retroperitoneal approach.
- Assuming a second assistant is automatically payable; N559 is not on the pre-approved list, and you must obtain prior authorization from a medical consultant to avoid rejection.
Billing Tips
- If performing multi-level fusion, ensure you append E366 for each additional level beyond the first to capture the correct total fee.
- If the procedure requires a combined thoracotomy and laparotomy approach, you must add E362 to the claim to receive the additional flat fee for the complex approach.
Provider Fee$1,122.00
Surgical Assistant Fee$87.57
Anaesthetist Fee$201.37
Non-Anaesthetist Fee$201.37
Effective: April 1, 2025
Category
Z. Spinal Surgical Procedures
Subcategory
SPINAL SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Spinal Surgical Procedures
Referral RequiredFrom: Physician, NursePractitioner
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