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N565
N565 – Repair of lipomeningocoele including release of tethered cord
OHIP Otolaryngology Code — SPINAL SURGICAL PROCEDURES · Schedule of Benefits
The N565 service covers the surgical repair of a lipomeningocele, including the release of a tethered cord. As a surgical procedure, payment includes pre-operative and post-operative care. Payment for an assistant (suffix 'B') is based on 8 base units plus time units. Payment for an anaesthesiologist (suffix 'C') is based on 10 base units plus time units. For full details on assistant and anaesthesia payment calculations, refer to the General Preamble (, ).
When to Use
- Use N565 for the primary surgical repair of a lipomeningocele where the clinical objective is the successful release of a tethered spinal cord.
- Select N565 when the procedure involves the excision of the lipomatous component and the subsequent untethering of the cord, as this is the definitive code for this specific pathology.
Common Pitfalls
- Attempting to bill a separate decompressive procedure code alongside N565 will result in a rejection, as all decompression is considered inclusive to this code.
- Failure to apply the correct age-based premium (e.g., for patients under 30 days or under 1 year) results in significant underpayment, as these are not automatically calculated by the system.
Billing Tips
- Ensure that any concurrent spinal fusion procedures are billed on the same claim, as they are explicitly permitted alongside N565 and represent additional billable work.
- Always verify the start time of the procedure to determine eligibility for E409 or E410 premiums, as these 50-75% increases are not automatically triggered by the surgical code alone.
Provider Fee$1,622.80
Surgical Assistant Fee$100.08
Anaesthetist Fee$154.90
Non-Anaesthetist Fee$154.90
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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