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Z269
Z269 – Augmentation of chin - with prosthetic implant
OHIP Psychiatric Code — MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Augmentation of chin - with prosthetic implant. This procedure is listed in the Schedule of Benefits under the heading 'Surgery for Correction of Down's Syndrome Facial Stigmata' within the 'Skull and Mandible' subsection of 'Musculoskeletal System Surgical Procedures'.
When to Use
- Use specifically for chin augmentation via prosthetic implant when performed as part of the reconstructive surgical correction of facial stigmata associated with Down's Syndrome.
- Use when the clinical documentation explicitly confirms the procedure is reconstructive in nature rather than cosmetic, as the Schedule of Benefits classifies this under Down's Syndrome facial stigmata correction.
Common Pitfalls
- Billing Z269 for elective cosmetic chin augmentation is a common audit trigger, as OHIP does not cover purely aesthetic procedures.
- Failure to document the specific diagnosis of Down's Syndrome and the associated facial stigmata being corrected can lead to claim rejection or recovery during post-payment audit.
- Attempting to bill this alongside other facial reconstruction codes (e.g., Z267 or Z268) without clear documentation of distinct, separate surgical sites or procedures may lead to claims being flagged for unbundling.
Billing Tips
- Ensure the operative report clearly details the use of a prosthetic implant, as the code specifically requires this for the $154.00 fee.
- If the procedure is performed on a patient under 16 years of age, remember to apply the appropriate age premium (e.g., 10% for ages 5-15) to maximize the procedural fee.
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