Z292 – Laryngoscopy - without biopsy
OHIP Psychiatric Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Direct laryngoscopy without biopsy is an endoscopic procedure to visually examine the larynx. As an Independent Operative Procedure (Z292), specific rules apply regarding pre-operative assessments (see ). The anaesthesia fee is based on 6 base units plus time units as defined in the Schedule (, ). Assistant services are not listed with base units but may be claimed under Independent Consideration using M400B with 6 base units plus time, requiring a letter of explanation from the surgeon (). This procedure is not payable when rendered with certain gastrointestinal endoscopies unless for a suspected laryngeal disease, in which case it requires manual review ().
When to Use
- Use Z292 for direct visualization of the larynx when no tissue sample is taken, distinguishing it from Z293 which involves biopsy.
- Use Z292 as a standalone procedure for diagnostic evaluation of laryngeal pathology, such as vocal cord paralysis or suspected lesions.
Common Pitfalls
- Billing Z292 alongside a gastroscopy or other GI endoscopy without a clear, documented clinical indication for laryngeal disease will lead to automatic rejection and requires manual review.
- Attempting to bill Z296 on the same day as Z292 will result in a rejection, as these are mutually exclusive procedures.
- Failing to provide a written letter of explanation when performing Z292 with GI procedures will result in the claim being denied during the mandatory manual review process.
Billing Tips
- Ensure the surgical assistant claims M400B with 6 base units plus time, and always include a letter of explanation from the surgeon to support the necessity of the assistant for this specific procedure.
- If performing Z292 in conjunction with a GI endoscopy, explicitly document the suspicion of laryngeal disease in the operative report to facilitate the required manual review by the medical consultant.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures, Surgical Assistants' Services, Anaesthesiologists' Services
When `Z292` is claimed in association with gastroscopy, oesophagoscopy, oesophagoscopy-gastroscopy, duodenoscopy, and small bowel push enteroscopy services for a suspicion of disease of the larynx, a written explanation must be submitted for manual review by a medical consultant.
1. E600 is not eligible for payment in addition to E643.
2. Z292 rendered in association with gastroscopy, oesophagoscopy, oesophagoscopy-gastroscopy, duodenoscopy, and small bowel push enteroscopy services is not eligible for payment unless the laryngoscopy service is rendered for suspicion of disease of the larynx. Claims for Z292 in these circumstances are assessed by a medical consultant on a manual review basis and require the submission of a written explanation.
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