Z399 – Oesophagoscopy - elective
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Elective oesophagoscopy-gastroscopy, with or without duodenoscopy. This is a surgical procedure to visually examine the upper part of the gastrointestinal tract, including the oesophagus, stomach, and the first part of the small intestine (duodenum). It is performed on an elective basis. As a surgical procedure, it includes the common elements of an insured service as defined in the Schedule of Benefits (-14) and the specific elements for surgical procedures, such as pre-operative evaluation, the procedure itself, and post-operative care.
When to Use
- Use Z399 for elective diagnostic oesophagogastroduodenoscopy (OGD) performed for routine surveillance or investigation of dyspepsia.
- Use Z399 when performing a standard upper endoscopy where no additional therapeutic interventions, such as foreign body removal (E690) or radiofrequency ablation (E813), are required.
Common Pitfalls
- Billing Z292 (laryngoscopy) alongside Z399 without explicit documentation of laryngeal pathology will result in automatic rejection or mandatory manual review.
- Attempting to claim after-hours procedure premiums (E409, E410) for Z399 is prohibited as the code is strictly defined as an elective procedure.
- Billing an admission assessment (A001/A007) for an elective hospital admission is incorrect, as this is considered a specific re-assessment included in the surgical fee.
Billing Tips
- If performing radiofrequency ablation for Barrett's esophagus during the same session, ensure E813 is billed as an add-on to maximize the total procedure value.
- If a foreign body is removed during the procedure, use E690 instead of Z399, as E690 is the specific therapeutic code for that intervention.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures, Diagnostic and Therapeutic Procedures
Z292 rendered in association with oesophagoscopy and oesophagoscopy-gastroscopy services is not eligible for payment unless the laryngoscopy service is rendered for suspicion of disease of the larynx. Claims for Z292 in these circumstances are assessed by a medical consultant on a manual review basis and require the submission of a written explanation.
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