Z320 – Insertion of voice prosthesis
OHIP Psychiatric Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
This service covers the surgical insertion of a voice prosthesis.
Independent Operative Procedure (IOP) Rules
As a Z-code, this is an Independent Operative Procedure (IOP) and is subject to the rules on page :.
- If the major pre-operative visit was rendered in the previous 12-month period prior to the IOP service by the same physician, only a minor assessment (if rendered by a General and Family Physician) or a partial assessment (if rendered by a specialist) is eligible for payment on the same day prior to the IOP service.
- When the major preoperative assessment is rendered on the same day as the IOP, no other consultation or assessment is eligible for payment if rendered prior to the IOP service by the same physician on the same day.
When to Use
- Use Z320 for the primary surgical insertion of a voice prosthesis in patients following a total laryngectomy.
- Use Z320 when performing a routine replacement of a voice prosthesis that requires a formal surgical procedure rather than a simple in-office exchange.
Common Pitfalls
- Billing Z320 alongside a consultation code on the same day is a common rejection; per IOP rules, only a minor or partial assessment is eligible if a major assessment occurred within the previous 12 months.
- Failing to apply the 85% rule when Z320 is performed alongside other surgical procedures under the same anesthesia will trigger an automatic adjustment or audit risk.
Billing Tips
- If the procedure is non-elective and performed after hours, ensure you append the appropriate premium (E409 or E410) to the Z320 claim to increase the procedural fee by 50% or 75% respectively.
- When performing multiple procedures during the same session, always list the procedure with the highest fee first to ensure the 85% payment adjustment is applied correctly to the secondary procedures.
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