Z353 – Incisional biopsy of chest wall tumour
OHIP Psychiatric Code — RESPIRATORY SURGICAL PROCEDURES · Schedule of Benefits
Performs an incisional biopsy of a tumour on the chest wall. This is categorized as an Independent Operative Procedure (Z353). As per the Surgical Preamble (-), the service includes: - Supervising or preparing the patient for the procedure. - Performing the biopsy. - Post-operative care, including managing recovery and arranging follow-up. - Discussion with the patient or their representative. - The fee also includes the major pre-operative visit if rendered on the same day. If the major pre-operative visit was performed within the prior 12 months, only a minor or partial assessment is payable on the day of the procedure (: ).
When to Use
- Use Z353 for an incisional biopsy of a chest wall mass where a tissue sample is obtained for pathological diagnosis.
- Use this code when the procedure is performed as an Independent Operative Procedure (IOP) to distinguish it from more extensive thoracic surgeries.
Common Pitfalls
- Billing a consultation or assessment on the same day as Z353 is a common rejection; the fee for Z353 already includes the major pre-operative visit.
- Failing to document the necessity for a surgical assistant when submitting M400B will lead to claim rejection, as this procedure does not automatically trigger assistant eligibility.
- Attempting to claim an additional minor assessment on the same day as Z353 when a major pre-operative visit occurred within the previous 12 months is often audited; ensure you only bill the appropriate partial or minor assessment code as permitted by SP4.
Billing Tips
- If you performed a major pre-operative visit within the last 12 months, bill only a minor or partial assessment on the day of the procedure to remain compliant with SP4.
- When billing for anaesthesia, ensure the claim reflects that the basic units are derived from a comparable procedure, as Z353 does not have its own assigned basic units.
Effective: April 1, 2025
P. Respiratory Surgical Procedures
RESPIRATORY SURGICAL PROCEDURES
Surgical
Respiratory Surgical Procedures
Payment for a surgical assistant (suffix B) requires authorization by a medical consultant and should be claimed using fee code M400B. The claim must include a letter from the surgeon outlining the reason the assistant was required.
The anaesthetist fee (suffix C) is based on the basic units of a comparable procedure plus time units, as no specific basic units are listed for this procedure.
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