Z223 – Manipulation under general anaesthetic - sole procedure
OHIP Psychiatric Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Manipulation under general anaesthetic. This is a surgical procedure performed on the shoulder, arm, or chest. For a similar procedure performed without general anaesthetic, refer to the Diagnostic and Therapeutic Procedures - Physical Medicine section of the Schedule of Benefits. See Surgical Preamble for further details.
When to Use
- Use Z223 for the manipulation of a joint (e.g., frozen shoulder) specifically when performed under general anaesthetic as the sole surgical procedure.
- Do not use this code for manipulations performed in the office or clinic setting without general anaesthetic; those must be billed under the Physical Medicine section of the Schedule.
Common Pitfalls
- Billing Z223 on the same day as any other insured service (e.g., a consultation or minor procedure) will result in the fee being reduced to nil.
- Attempting to bill a surgical assistant fee for this procedure will result in rejection, as surgical assistant services are explicitly ineligible for payment with Z223.
Billing Tips
- Ensure your operative report clearly documents the indication for the manipulation and the use of general anaesthetic to satisfy the requirements of GP8:22.
- If the procedure is performed after hours or on weekends, ensure you append the appropriate non-elective procedure premium (E409A or E410A) to the base fee, as these are permitted add-ons.
Effective: April 1, 2026
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Medical record must contain the indication for manipulation under general anaesthetic.
Without general anaesthetic, see Diagnostic and Therapeutic Procedures - Physical Medicine.
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