Z305 – Nasal polyp - multiple or involving general anaesthetic - unilateral
OHIP Psychiatric Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
A unilateral procedure for the excision of multiple nasal polyps, or any nasal polyp excision that requires a general anaesthetic. As a #-prefixed service, when performed in a hospital or an Integrated Community Health Services Centre (ICHSC), the costs for premises, equipment, supplies, and personnel are not billed by the physician (see ). This is an Independent Operative Procedure (IOP), which has specific payment rules regarding pre-operative assessments (see ).
When to Use
- Use Z305 when performing a unilateral excision of multiple nasal polyps in an office or hospital setting.
- Use Z305 for any nasal polyp excision, regardless of count or laterality, if the procedure is performed under general anaesthesia.
Common Pitfalls
- Do not bill Z305 with Z304, as these are mutually exclusive codes for nasal polyp procedures.
- As an Independent Operative Procedure (IOP), billing a consultation or assessment on the same day as Z305 is restricted; ensure you adhere to the pre-operative assessment rules in SP4 to avoid rejections.
- Failing to account for the 85% rule when performing multiple procedures during the same operative session will lead to payment adjustments.
Billing Tips
- If performing bilateral procedures, ensure you bill the appropriate codes for the second side, but remember that pre- and post-operative benefits are only claimable as if a single procedure was performed.
- Always verify if the procedure meets the criteria for non-elective premiums (E409A or E410A) if performed outside standard hours, as these significantly increase the base fee.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
Not eligible for payment if rendered in conjunction with tonsillectomy and adenoidectomy or quadroscopy. Note from Z298, which is under the same Nasopharynx section, may apply contextually.
When multiple or bilateral IOPs like Z305 are performed at the same time by the same physician, the listed procedural benefits should be claimed in full but the pre- and post-operative benefits should be claimed as if only one procedure had been performed.
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