Z304 – Nasal polyp - single
OHIP Psychiatric Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Surgical excision of a single nasal polyp. This service is classified as an Independent Operative Procedure (IOP). For excision of multiple polyps or when a general anaesthetic is required, see Z305.
This procedure can be performed with a flexible endoscope, in which case add-on code E839 is applicable.
As an IOP, specific rules from apply regarding billing other assessments on the same day:
- If a major pre-operative assessment has been performed by the same physician in the preceding 12 months, only a minor assessment (by a GP) or partial assessment (by a specialist) is payable on the same day before the procedure.
- If the major pre-operative assessment is performed on the same day as the IOP, no other consultation or assessment is payable prior to the procedure on the same day by the same physician.
When to Use
- Use Z304 for the simple excision of a single, isolated nasal polyp performed under local anaesthetic in an office or clinic setting.
- Use Z304 when the procedure is performed via flexible endoscopy, ensuring you also append the E839 add-on code to the claim.
Common Pitfalls
- Billing Z304 for multiple polyps; this code is strictly for a single polyp, whereas Z305 must be used for multiple excisions or cases requiring general anaesthetic.
- Attempting to bill a consultation or assessment on the same day as Z304; as an Independent Operative Procedure (IOP), the assessment is bundled into the surgical fee unless specific SP4 criteria for minor/partial assessments are met.
- Failing to document the use of a flexible endoscope when claiming the E839 add-on, which is a frequent trigger for manual audit.
Billing Tips
- Always verify if the patient has had a major pre-operative assessment in the last 12 months, as this dictates whether you can bill a minor/partial assessment on the same day as the procedure.
- If performing the procedure after hours or on a weekend, ensure you apply the appropriate E409 or E410 premium to the Z304 base fee to maximize reimbursement.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
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