Z132 – Insertion of tissue expander
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure for the insertion of a tissue expander. Payment for this service is not eligible when performed for post-mastectomy reconstruction of the breast. Prior authorization from the Ministry of Health may be required for certain cases, such as for scars on the legs. Add-on codes are available for the insertion of additional expanders: E527 for an additional expander through the same incision, and E528 for an additional expander through a different incision.
When to Use
- Use Z132 for the insertion of a tissue expander to address significant scarring or skin defects resulting from trauma or burns, provided it is not related to breast reconstruction.
- Use Z132 for reconstructive procedures involving congenital anomalies or non-mastectomy related skin deficiencies where tissue expansion is required to facilitate closure.
Common Pitfalls
- Billing Z132 for any stage of post-mastectomy breast reconstruction will result in an automatic rejection, as this code is explicitly excluded for that purpose.
- Failing to obtain and document prior Ministry of Health authorization for non-standard sites, such as leg scars, will lead to claim denial during audit.
Billing Tips
- If multiple expanders are placed, ensure you correctly append E527 for same-incision placements or E528 for different-incision placements to maximize the procedural fee.
- Always verify if the patient qualifies for age-based surgical premiums, as these percentages apply to the base fee of Z132 and can significantly increase the total claim value.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
Z132 is not eligible for payment for post-mastectomy reconstruction of the breast.
Authorization may be required from the Ministry of Health (e.g. for scars of legs, etc.).
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