Z297 – Insertion of prosthesis for nasal septal perforation
OHIP Psychiatric Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Insertion of a prosthesis for nasal septal perforation. As an Independent Operative Procedure (IOP), payment rules for pre-operative assessments apply. Specifically, if the major pre-operative visit was rendered in the previous 12-month period by the same physician, only a minor assessment (by a General/Family Physician) or a partial assessment (by a specialist) is payable on the same day prior to the IOP service. If the major pre-operative assessment is rendered on the same day as the IOP, no other consultation or assessment is eligible for payment prior to the service by the same physician.
When to Use
- Use Z297 when inserting a pre-fabricated or custom-fitted nasal septal button to manage a symptomatic septal perforation.
- Use this code exclusively for the insertion procedure; do not use it for the initial diagnostic assessment of the perforation.
Common Pitfalls
- Billing a major consultation or assessment on the same day as Z297 will trigger a rejection; only a minor or partial assessment is permitted if the major assessment occurred within the previous 12 months.
- Attempting to bill Z297 alongside other nasal surgical procedures without applying the 85% multiple procedure rule for the lesser procedure will lead to payment adjustments.
- Failure to recognize Z297 as an Independent Operative Procedure (IOP) often leads to incorrect bundling with unrelated office visits.
Billing Tips
- If performing Z297 on a pediatric patient, ensure the appropriate age premium code is appended to capture the 10-30% fee increase based on the patient's age.
- If the procedure is performed non-electively during after-hours, ensure E409 or E410 is applied to the Z297 fee to maximize the procedural reimbursement.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
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