Z415 – Removal and/or replacement of implantable cardioverter defibrillator
OHIP Psychiatric Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This service covers the surgical removal and/or replacement of an implantable cardioverter defibrillator (ICD). The fee for the surgeon (Z415A) is a set amount. The fee for the assistant (Z415B) is calculated based on 6 basic units plus time units. The fee for the anaesthetist (Z415C) is calculated based on 7 basic units plus time units. Time unit calculations are governed by the general rules for surgical assistants and anaesthesiologists found in the General Preamble (, ).
When to Use
- Use Z415A for the complete surgical removal and/or replacement of an ICD generator, as this code is specifically designated for this procedure.
- Use Z415A when the procedure involves the revision of the pulse generator system, distinguishing it from lead-only procedures or diagnostic testing codes like R753 or R761.
Common Pitfalls
- Billing Z415A alongside a separate consultation or admission assessment is generally disallowed, as the pre-operative assessment is considered part of the surgical fee unless it qualifies as a major pre-operative visit.
- Failing to document the specific nature of the ICD intervention can lead to rejections if the claim is audited against lead-only procedures, which require different coding.
- Incorrectly applying after-hours premiums (E409, E410) to the surgeon's fee without verifying that the case was non-elective or delayed by an intervening surgical emergency.
Billing Tips
- Ensure that surgical assistants (Z415B) and anaesthesiologists (Z415C) bill their respective codes using the correct basic unit values (6 and 7, respectively) plus time units as defined in the General Preamble.
- When the patient is under 16 years of age, remember to apply the age-based fee premium to the surgeon's and assistant's fees to ensure accurate reimbursement.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
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