E383

PDF page 785 / Z1

OTHER TERMS AND DEFINITIONS
                  1. The preamble to the Musculoskeletal System Surgical Procedures section also applies to this
                     section as applicable (e.g. fractures).
                  2. Fusion of one disc level (one motion segment) includes two levels of instrumentation.
                  3. Obtaining bone for grafting is included as a component of all fusion procedures and is not
                     eligible for payment when performed with any fusion procedure.
                  4. Thoracotomy performed in conjunction with spinal procedures by a surgeon not performing the
                     spinal surgery constitutes M137 (P14).
                  5. Laparotomy performed in conjunction with spinal procedures by a surgeon not performing the
                     spinal surgery constitutes S312 (S34).
                  6. Three-dimensional (3D) computer-assisted stereotactic navigation (E378) must include the pre-
                     operative or intra-operative generation of axial, sagittal and coronal reformatted images that are
                     processed and virtually represented in 3D by a surgical navigational system. In addition, the
                     surgical navigational system must be used to reflect the position of an image-guided (tracked)
                     surgical tool(s) relative to the patient's anatomy. This may be performed by either frame or
                     frameless technique and applies to any spinal level.
                  7. Two-dimensional (2D) computer-assisted stereotactic navigation (E379) must include the intra-
                     operative generation of antero-posterior, lateral or multiple oblique 2D views that are processed
                     and virtually represented in 2D by a surgical navigational system. In addition, the surgical
                     navigational system must be used to reflect the position of an image-guided (tracked) surgical
                     tool(s) relative to the patient's anatomy. This may be performed by either frame or frameless
                     technique and applies to any spinal level.
                     Note:
                     The use of an intra-operative imaging tool such as a portable x-ray, fluoroscope (2D or 3D), CT,
                     MRI or ultrasound for "live" localization without a surgical navigational system as defined
                     above does not constitute E378 or E379 and is not eligible for payment.
                  8. Acute spinal cord injury premium (E383) is only eligible for payment when rendered to patients
                     who are described under ASIA impairment scale ratings A to C and have acute conditions
                     which have been present for 6 weeks or less.

PDF page 787 / Z3

SPINAL SURGICAL PROCEDURES
 ANTERIOR SPINAL DECOMPRESSION
                                                                                                      Asst    Surg     Anae
    All levels
# E383     - acute spinal cord injury premium ............................... add                             255.00
# E382     - spinal duroplasty using autologous/allogenic/synthetic
             tissue.......................................................................... add             244.80
    Cervical
# N500 Disc excision (one level) .........................................................            10     1097.90    10
# N501 Vertebrectomy (removal of vertebral body and excision of
          adjacent discs) ...................................................................          11    1267.15    11
# E360    - each additional level decompression, to N500 or N501
            ................................................................................... add           306.00
# N569 Anterior cervical decompression by intra-oral approach......... 15      1442.95       15
     Note:
     No other anterior cervical decompression codes (i.e. N500, N501, E360) are eligible for
     payment when rendered with anterior cervical decompression by intra-oral approach (N569).

PDF page 790 / Z6

All levels
# E383     - acute spinal cord injury premium ............................... add                                         255.00
# E382     - spinal duroplasty using autologous/allogenic/synthetic
             tissue.......................................................................... add                         244.80
# N521 Re-opening of laminectomy for post-op haematoma/infection         7     357.00       8
# N522 Re-opening of laminectomy for repair of CSF leak................. 7     535.50       8
     Note:
     1.N521 and N522 are not eligible for payment when rendered with any service in the Spinal
       Surgical Procedures section except duroplasty (E382) if required.
     2.N521 is not eligible for payment if rendered with N522.
    Cervical / Thoracic
# N509 One level - unilateral...............................................................                    9        1004.70          12
# N510 One level - bilateral.................................................................                   9        1346.05          17
# E374    - foramen magnum decompression < 3cm as part of
            cervical decompression, to N510............................... add                                            357.00
# E361    - each additional level decompressed including disc
            excision - unilateral or bilateral, to N509 or N510 ...... add                                                260.80
# N520 One level - laminoplasty (includes fixation of lamina) ............                                      9        1514.70          14
# E380   - each additional level - laminoplasty (includes fixation of
           lamina), to N520......................................................... add                                  357.00
# E368          - first disc excision, to N509, N510 or N520................. add                                         306.00
    Lumbar
# N511 One level - unilateral...............................................................                    8         800.70          15
# N512 One level - bilateral.................................................................                   8        1118.90          15
# E368   - first disc excision, to N511 or N512............................ add                                           306.00
# N524 One level - bilateral canal enlargement - unilateral approach                                            9        1300.25          15
# E361          - each additional level decompressed including disc
                  excision - unilateral or bilateral, to N511, N512 or N524
                  ................................................................................... add                 260.80
# N571 Percutaneous discotomy ........................................................                          6         255.00          8
# E385   - each additional level of percutaneous discotomy, to N571
           ................................................................................... add                          71.40
    Removal of Vertebral Body including Pedicles for Osteotomy
# N574 Above cord and conus (includes partial rib resection) - each
         level ....................................................................................             9        1020.00          13
# N575 Below conus - each level ........................................................                        9         765.00           9
# N576 Smith Peterson Osteotomy - each level .................................                                  9         255.00           9

PDF page 794 / Z10

#
                                    SPINAL SURGICAL PROCEDURES
    FRACTURES OF THE SPINE
                                                                                                            Asst         Surg         Anae
    # F200 No reduction, brace (includes Halo orthosis), total care by
             operating surgeon...............................................................                            178.50
    # F201 Closed reduction, fracture/dislocation (Halo or caliper traction)                                  6          280.50          6
    # E383   - acute spinal cord injury premium, to F201 ................. add                                           255.00
    # N572 Open reduction, any single level, spine fracture/dislocation,
               anterior/posterior ................................................................ 8 1097.30 11
    # E395     - open reduction, additional level, spine fracture/
                 dislocation, anterior/posterior, to N572....................... add                  306.00
          [Commentary:
          For closed and open reduction of sacral or sacro-iliac fractures and/or dislocations, see listings
          in the Pelvis and Hip section of the Schedule.]
    # E383    - acute spinal cord injury premium, to N572................. add        255.00
    # E362    - combined thoracotomy/laparotomy, to N572.............. add            153.00
    # E378    - 3D stereotactic spinal procedure, to N572 ................. add       510.00
    # E379    - 2D stereotactic spinal procedure, to N572 ................. add       510.00
          [Commentary:
          See Spinal Surgical Procedures Preamble for definition of eligible 2D and 3D stereotactic
          navigation systems.]
    # N573 Anterior odontoid screw fixation..............................................                     8        1020.00          11
    # E378   - 3D stereotactic spinal procedure, to N573 ................. add                                          510.00
    # E379   - 2D stereotactic spinal procedure, to N573 ................. add                                          510.00
    # N570 Vertebroplasty (injection of bone cement) as sole procedure,
             first level .............................................................................        7        1004.50           9
    # E388   - vertebroplasty combined with any other procedure, first
                level, to other procedure ............................................ add                               204.00
    # E391   - vertebroplasty, each additional level, to N570 or E388
                 ................................................................................... add                 252.95
    # N583 Kyphoplasty (balloon tamp and injection of bone cement) as
             sole procedure, first level....................................................                   8       1201.55          11
    # E392   - kyphoplasty combined with any other procedure, first
               level, to other procedure ............................................ add                                510.00
    # E393   - kyphoplasty, each additional level, to N583 or E392.. add                                                 510.00
             Note:
             1.Decompressive services at the level of the fracture are not eligible for payment when
               rendered with N572 as they are included in the open reduction.
             2.No other services in the Spinal Surgical Procedures section are eligible for payment when
               rendered with N573 except E378 or E379.
             3.No other services in the Spinal Surgical Procedures section are eligible for payment when
               rendered with N570 except E391.
             4.No other services in the Spinal Surgical Procedures section are eligible for payment when
               rendered with N583 except E393.
             [Commentary:
             Fusion procedures are eligible for payment when performed in addition to N572.]

PDF page 795 / Z11

SPINAL SURGICAL PROCEDURES
 TUMOURS/INFECTIONS OF THE SPINE
                                                                                       Asst   Surg     Anae
# E386   - extradural decompression - spinal cord or cauda equina -
           tumour or infection ............................................. add 42%
     Note:
     E386 only applies to the major decompressive procedure.
# N553 Simple soft tissue tumour excision under 5cm .......................             6     204.00    8
# N554 Radical soft tissue tumour excision 5cm and greater .............                9     484.50    13
    Spinal osteomyelitis
# N549 - incision and drainage including sequestrectomy, anterior
          approach ............................................................................ 7 632.40 10
# N548 - incision and drainage only, posterior approach ..................                      6 102.00  7
# N550 - sequestrectomy, posterior approach ..................................                  6 357.00 6
     Note:
     N548 is not eligible for payment when rendered with N550 as it is included in the N550 service.
# N560 Intradural extramedullary spinal tumour(s) - partial or total
          removal............................................................................... 8 2536.80 10
# N561 Intradural intramedullary spinal tumour(s) - partial or total
          removal............................................................................... 9 2927.70 12
# E382    - spinal duroplasty using autologous/allogenic/synthetic
            tissue, to N560 or N561 ............................................. add               244.80
# E383    - acute spinal cord injury premium, to N560 or N561... add                                255.00
      Note:
      1.No other decompressive codes are eligible for payment when rendered with N560 or N561.
      2.N560 is not eligible for payment when rendered with N561.

PDF page 799 / Z15

SPINAL SURGICAL PROCEDURES
 PROCEDURES INVOLVING NEURAL ELEMENTS
                                                                                        Asst      Surg        Anae
# Z941 Percutaneous diagnostic stimulation of spinal cord, trigeminal
         nerve root and / or ganglion ...............................................    6        331.50       8
# Z942 Implantation or revision of stimulation pack or leads ..............              6        306.00       8
# Z943 Programming infusion pump or dorsal column stimulator.......                               142.20
# Z944 Lumbar sub-arachnoid drainage of CSF.................................                       89.75
# N527 Percutaneous cordotomy or tractotomy..................................           6         469.20       8
# N529 Medullary spinal trigeminal tractotomy ...................................       10       1020.00       15
# E383   - acute spinal cord injury premium, to N529 ................ add                         255.00
# N564 Open myelotomy for lesion - unilateral or bilateral .................  8  1020.00                       10
      Note:
      No decompressive codes are eligible for payment when rendered with N529 or N564.
# N523 AV malformation of cord - excision/obliteration....................... 10 1891.70                       13
# E383    - acute spinal cord injury premium, to N523................. add        255.00
      Note:
      No other decompressive codes are eligible for payment when rendered with N523.
# N555 Insertion / revision / removal of implantable infusion pump ....                          590.40        8
# N530 Implantation of spinal cord stimulating electrode by
          laminectomy ....................................................................... 8 1008.90        10
     Note:
     N530 is not eligible for payment when rendered with any decompressive codes.
# N563 Implantation of permanent subcutaneous reservoir including
         laminectomy ....................................................................... 11 510.00         11
     Note:
     N563 is not eligible for payment when rendered with any decompressive codes.
# N531 Removal of any stimulation pack or electrode ........................ 6    306.00      7
     Note:
     N531 is not eligible for payment when rendered with any other services in the Spinal Surgical
     Procedures section

PDF page 800 / Z16

SPINAL SURGICAL PROCEDURES
PROCEDURES INVOLVING NEURAL ELEMENTS
                                                                                                           Asst         Surg          Anae
    Sympathectomy - unilateral
# N542 - cervical ...............................................................................            6          357.00           6
# N543 - cervico-dorsal .....................................................................                10         586.50          10
# N544        - thoracic approach...............................................................              9         433.50          13
# N545        - lumbar ................................................................................       6         295.80           6
# N557 Syringo-subarachnoid shunt................................................... 8 1224.00 12
# N558 Syringopleural/syringoperitoneal shunt...................................     9 1428.00 13
# E383    - acute spinal cord injury premium, to N557 or N558... add                    255.00
      Note:
      N557, N558 are not eligible for payment when rendered with any decompressive service.
# N562 Intradural neurolysis of unusual lesions e.g. diastematomyelia,
          tethered conus, intramedullary haematoma, etc. including
          laminectomy .......................................................................                 8        1224.00          12
# E361    - each additional level decompressed including disc
            excision - unilateral or bilateral, to N562.................... add                                         260.80
# E383    - acute spinal cord injury premium, to N562................ add                                               255.00
# E382    - spinal duroplasty using autologous/allogenic/synthetic
            tissue, to N562 ........................................................... add                             244.80
         Note:
         N562 is not eligible for payment when rendered with any other decompressive codes except
         additional levels (E361).
# N577 Intradural rhizotomy anterior/posterior (uni/bilateral) - any
          number of roots ..................................................................                  8        1276.65          10
# N578 Dorsal root entry zone lesions for pain relief – any number of
          levels ..................................................................................           8        1020.00          10
         Note:
         N577, N578 are not eligible for payment when rendered with any service in the Spinal Surgical
         Procedures section.

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