Z336 – Biopsy of pleura, needle
OHIP Psychiatric Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Performs a needle biopsy of the pleura, a procedure which includes diagnostic aspiration. As this is an Independent Operative Procedure (IOP), specific payment rules for pre-operative assessments apply as detailed in the Surgical Preamble (). If a major pre-operative visit was rendered within the 12 months prior to the IOP service by the same physician, only a minor assessment (by a General/Family Physician) or a partial assessment (by a specialist) is eligible for payment on the same day. 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 by the same physician on the same day.
When to Use
- Use Z336 when performing a diagnostic needle biopsy of the pleura, which inherently includes the diagnostic aspiration of pleural fluid.
- Use this code for pleural biopsies performed in an outpatient or inpatient setting where the primary intent is obtaining tissue for histopathological diagnosis.
Common Pitfalls
- Billing a consultation or major assessment on the same day as Z336 is a common rejection; per the Surgical Preamble, only a minor or partial assessment is eligible if a major assessment occurred in the previous 12 months.
- Attempting to bill a surgical assistant fee for Z336 will result in an automatic rejection, as surgical assistant services are explicitly excluded for this procedure under GP85.
- Failing to document the specific clinical necessity for a non-elective procedure when claiming after-hours premiums like E409A or E410A can lead to audit recovery.
Billing Tips
- If the procedure is non-elective and performed after hours, ensure the start time is clearly documented to support the application of E409A or E410A premiums.
- When performing multiple procedures during the same session, remember that Z336 will be subject to the 85% multiple procedure rule if it is not the major procedure performed.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
This is an Independent Operative Procedure (IOP).
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