Z347 – Anterior mediastinotomy - when sole procedure performed
OHIP Psychiatric Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Z347A is for an anterior mediastinotomy when it is the sole procedure performed. As a 'Z' code, this service is classified as an Independent Operative Procedure (IOP). The fee for an IOP includes pre- and post-operative care, with specific rules about billing for assessments on the same day. For detailed rules on IOPs, pre- and post-operative care, and billing with other procedures, refer to the Surgical Preamble (-).
When to Use
- Use Z347A when performing a standalone anterior mediastinotomy for biopsy or diagnostic purposes where no other surgical procedure is performed during the same operative session.
- Use this code for diagnostic mediastinal exploration when the intent is limited to the mediastinotomy procedure itself, distinguishing it from more extensive procedures like mediastinal lymph node excision (Z353).
Common Pitfalls
- Billing a consultation or assessment on the same day as Z347A is a common rejection; as an IOP, the pre-operative assessment is included in the fee unless specific exceptions in the Surgical Preamble are met.
- Attempting to bill Z347A alongside other surgical procedures performed under the same anesthesia will trigger payment adjustments; ensure you are not unbundling procedures that should be claimed under a more comprehensive code.
- Failure to document the specific clinical necessity for the mediastinotomy can lead to audit recovery, as the code is strictly for the sole procedure.
Billing Tips
- If the procedure is performed after hours, ensure you append the appropriate premium (E409 or E410) to the Z347A fee to maximize reimbursement for non-elective, urgent cases.
- When performing multiple procedures during the same hospitalization, remember that Z347A is subject to the 85% rule for secondary procedures if it is not the primary surgical intervention.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
This service is an Independent Operative Procedure (IOP).
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