Z214 – Open biopsy or taking of bone graft
OHIP Psychiatric Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure listed in the Musculoskeletal System section (Part Z) of the Schedule. As a 'Z-prefix' procedure, it is subject to specific payment rules regarding pre-operative and post-operative care. According to , an admission assessment by the surgeon who has previously assessed the patient for the same illness is considered a specific re-assessment. Visits by the surgeon around the time of the surgery are also subject to specific rules that differ from non-Z prefix surgeries, as detailed in and .
When to Use
- Use Z214 for an open bone biopsy procedure where a tissue sample is obtained for pathological analysis.
- Use Z214 when harvesting an autologous bone graft from a donor site, such as the iliac crest, to facilitate a separate reconstructive or fusion procedure.
Common Pitfalls
- Billing Z214 in conjunction with a definitive fracture repair or fusion procedure at the same site may trigger a 'duplicate' or 'included' service rejection if the biopsy is considered an integral part of the primary surgical approach.
- Failing to recognize Z214 as a Z-prefix code leads to improper billing of pre-operative assessments; remember that the admission assessment is deemed a specific re-assessment under GP23, not a new consultation.
Billing Tips
- Ensure the operative report clearly distinguishes the bone graft harvest as a distinct procedural step if you intend to bill it alongside other musculoskeletal procedures, as the Ministry may view it as part of the primary surgery's global fee.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
The fee for the surgical procedure itself (suffix A) is a set amount.
The fee for an assistant (suffix B) is calculated using basic units plus time units. The number of basic units is listed in the 'Asst' column for the procedure. Time units accrue for each 15-minute interval, with values increasing after the first hour and after 2.5 hours. The unit fee is $12.51. See - for details.
The fee for an anaesthetist (suffix C) is calculated using basic units plus time units. The number of basic units is listed in the 'Anae' column for the procedure. Time units accrue for each 15-minute interval, with values increasing after the first hour and after 1.5 hours. The unit fee is $15.49. See - for details.
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