Z182 – Breast capsulectomy
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
The specific description for Z182 is not available in the provided context. As a Z-prefix code, it is classified under Integumentary System Surgical Procedures. The service is billable by the surgeon (suffix A), an assistant (suffix B), and an anaesthetist (suffix C). Fees for the assistant and anaesthetist are calculated based on basic and time units, as defined in the General Preamble. This procedure is eligible for various premiums, including those for patient age, after-hours service, and trauma, and is subject to standard surgical billing rules regarding pre-operative assessments and cancellations.
When to Use
- Use Z182 specifically for the surgical excision of a fibrous breast capsule, typically performed during a revision of a breast implant procedure.
- Use this code when the clinical documentation confirms a formal capsulectomy (excision of the capsule) rather than a simple capsulotomy (incision of the capsule), which may be billed under different surgical descriptors.
Common Pitfalls
- Billing Z182 in conjunction with other breast revision codes without ensuring the procedures are distinct and not considered 'incidental' to the primary surgery, which risks rejection for unbundling.
- Failing to document the specific extent of the capsulectomy, as auditors may downgrade the claim if the procedure performed was a lesser capsulotomy rather than a full capsulectomy.
Billing Tips
- Ensure that if Z182 is performed bilaterally, the claim is submitted with the appropriate bilateral indicator (e.g., modifier 'BI') to receive the correct percentage increase on the second side.
Effective: April 1, 2025
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
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