Z268 – Augmentation of zygoma (bilateral) - with autogenous bone or cartilage
OHIP Psychiatric Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Performs a bilateral augmentation of the zygoma (cheekbones) using autogenous (patient's own) bone or cartilage. This procedure is indicated for the correction of facial stigmata associated with Down's Syndrome. As per the note on page of the Schedule of Benefits, this fee includes the harvesting and grafting of the necessary bone or cartilage grafts. As a surgical procedure, it includes the common elements of all insured services as described on pages - of the Schedule, such as obtaining history, maintaining records, and conferring with other professionals. The service rendered personally by the surgeon (suffix A) includes the pre-operative evaluation, the surgical procedure itself, and normal post-operative care.
When to Use
- Use Z268 specifically for the bilateral augmentation of the zygoma in patients diagnosed with Down's Syndrome to correct associated facial stigmata.
- Use this code when the surgical plan involves the harvesting and grafting of autogenous bone or cartilage, as these components are bundled into the fee.
Common Pitfalls
- Do not bill separately for the harvesting of the autogenous bone or cartilage graft, as this is explicitly included in the Z268 fee per page N34.
- Avoid billing a hospital admission assessment as a separate claim, as Z268 is a 'Z' prefix code that precludes this unless it qualifies as the major pre-operative visit for scheduling the surgery.
Billing Tips
- Ensure the medical record explicitly documents the diagnosis of Down's Syndrome and the specific facial stigmata being addressed to satisfy the audit requirements outlined on page N34.
- If the patient is under 16 years of age, remember to apply the appropriate age-based surgical premium (e.g., AGE_PREMIUM_5Y_TO_16Y) to maximize the claim value.
Effective: April 1, 2025
N. Musculoskeletal System Surgical Procedures
MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Documentation of medical necessity for the procedure, specifically for the correction of Down's Syndrome facial stigmata, is required in the patient's medical record.
* Includes harvesting and grafting of bone or cartilage grafts.
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