Z298 – Nasopharynx Examination Under General Anesthetic (EUGA) for malignant disease
OHIP Psychiatric Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This service covers an examination under general anaesthesia (EUGA) of the nasopharynx, which may include the oropharynx, oral cavity, and hypopharynx, for the evaluation of malignant disease. This procedure includes any biopsies performed during the examination. This is an Independent Operative Procedure (IOP), meaning it is subject to the specific pre- and post-operative care rules outlined on page of the Schedule of Benefits. It is explicitly not payable if rendered in conjunction with a tonsillectomy, adenoidectomy, or quadroscopy.
When to Use
- Use Z298 for a diagnostic examination under general anesthesia specifically to evaluate suspected or known nasopharyngeal malignancy.
- Use this code when performing biopsies of the nasopharynx, oropharynx, or hypopharynx during an EUGA, as the biopsy fee is included in the Z298 procedural benefit.
Common Pitfalls
- Billing Z298 alongside a tonsillectomy or adenoidectomy will trigger an automatic rejection as these procedures are mutually exclusive.
- Attempting to bill a consultation or major assessment on the same day as Z298 will result in a rejection because Z298 is an Independent Operative Procedure (IOP) that bundles pre-operative care.
- Failing to secure prior authorization from a medical consultant when claiming an assistant fee via M400B will lead to non-payment of the assistant portion.
Billing Tips
- If you perform multiple IOPs during the same session, claim the full procedural fee for each, but ensure you only bill the pre- and post-operative care components as if a single procedure was performed.
- Always document the specific clinical indication for malignancy to justify the use of Z298 over other non-malignancy-related diagnostic codes.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
Since there is no basic unit value listed for an assistant ('Asst'), assistant services, when required, are claimed using M400B. This service is only eligible for payment upon authorization by a medical consultant following submission of a letter from the surgeon outlining the reason the assistant was required. The number of basic units is that listed under 'Anae' (6). See .
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