Z138 – Replacement of tissue expander by permanent prosthesis
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Replacement of tissue expander by permanent prosthesis.
When to Use
- Use Z138 for the secondary stage of breast reconstruction when the previously placed tissue expander is removed and replaced with a permanent silicone or saline implant.
- Use this code for the surgical exchange of a tissue expander following successful expansion of a skin flap or scar site in non-breast reconstructive cases.
Common Pitfalls
- Do not bill Z138 in conjunction with Z137, as the removal of the expander is considered an integral component of the replacement procedure.
- Avoid billing Z138 if the expander is removed due to infection or complication without immediate replacement, as this should be billed as a removal procedure (e.g., Z094) rather than a replacement.
- Ensure the procedure is not miscoded as a primary insertion (Z132), which carries different clinical requirements and fee structures.
Billing Tips
- If the procedure involves significant additional complexity beyond the standard exchange, document the operative time and clinical justification to support an 'I.C.' (Independent Consideration) claim if the $195.85 fee is deemed inadequate.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
The following notes apply to the related procedure for insertion of a tissue expander and may be relevant: Z132 is not eligible for payment for post-mastectomy reconstruction of the breast.
The following notes apply to the related procedure for insertion of a tissue expander and may be relevant: Authorization may be required from the Ministry of Health (e.g. for scars of legs, etc.).
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