Z142 – Removal of breast prosthesis
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This billing code represents a surgical procedure within the Integumentary System section. The surgeon's fee is claimed with suffix A. Assistant and anaesthetist services are also payable when medically necessary, claimed with suffix B and C respectively. The amount payable for assistant and anaesthetist services is determined by a unit system, adding basic units (specific to the procedure) and time units (based on duration), as detailed in the General Preamble (, ). Various premiums for after-hours work (e.g., E409), trauma (E420), and patient age may also apply.
When to Use
- Use Z142 for the surgical removal of a breast prosthesis, such as in cases of implant rupture, capsular contracture, or patient request for explantation.
- Distinguish Z142 from Z143 (Removal of breast prosthesis with capsulectomy); if the procedure involves the removal of the fibrous capsule, Z143 is the more appropriate and higher-valued code.
Common Pitfalls
- Billing Z142 alongside a consultation or assessment code on the same day is often rejected unless the assessment is the 'major pre-operative visit' where the decision to operate was finalized.
- Failure to document the specific clinical indication (e.g., rupture, infection, or pain) can lead to audit recovery, as simple elective cosmetic removal may have different coverage implications than medically necessary removal.
Billing Tips
- Ensure that if a capsulectomy is performed in conjunction with the removal, you bill Z143 instead of Z142 to accurately reflect the complexity and surgical work performed.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services require documentation in the patient's medical record to establish that the service was provided, was medically necessary, and matches the service claimed. See Appendix G of the Schedule for detailed requirements.
If the service is performed by a Medical Trainee under supervision, the medical record must identify: the Supervising Physician; the Medical Trainee and level of training; the description of the insured service performed; patient consent for supervision; and evidence of review by the Supervising Physician. The Supervising Physician must sign off on the service.
For procedures prefixed with 'Z', an admission assessment by the surgical specialist who has previously assessed the patient for the same illness is deemed a specific re-assessment.
A hospital admission assessment by the surgeon is not eligible for payment, unless it is the 'major pre-operative visit' (the consultation or assessment where the decision to operate is made).
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