Z095 – Removal tissue expander injection port - local anaesthetic
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This procedure involves the surgical removal of an injection port for a previously placed tissue expander. This service is performed under local anaesthesia and is only billable when it is the sole procedure. This service is the local anaesthetic equivalent of Z094, which is for the same procedure performed under general anaesthetic.
When to Use
- Use Z095 when performing an office-based removal of a tissue expander injection port under local anaesthetic as a standalone procedure.
- Select Z095 when the patient has completed the expansion phase and the port is no longer required, provided no other surgical procedures are performed during the same encounter.
Common Pitfalls
- Do not bill Z095 if the procedure is performed under general anaesthetic; use Z094 instead as they are mutually exclusive.
- Avoid billing Z095 alongside other surgical procedures, as it is only billable when it is the sole procedure performed during the visit.
- Failure to document the use of local anaesthetic can lead to audit scrutiny, as this is the defining clinical requirement distinguishing it from Z094.
Billing Tips
- Ensure you apply the appropriate age-based premiums (e.g., for pediatric patients) to maximize the procedural fee, as Z095 is eligible for these modifiers.
- If the procedure is performed after hours for non-elective reasons, ensure you attach the correct premium code (E409 or E410) to the Z095 claim to increase the base fee by the applicable percentage.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
All insured services must be documented in appropriate records. The record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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