Z426 – Bone marrow transplantation - infusion into recipient
OHIP Psychiatric Code — HAEMATIC AND LYMPHATIC SURGICAL PROCEDURES · Schedule of Benefits
Performs the infusion of bone marrow into a recipient as part of a bone marrow transplantation procedure. This service is listed as a team fee alongside Z425 (aspiration from donor). Per the Schedule, bone marrow transplantation is not an insured benefit for all conditions. Physicians are required to consult with a Ministry of Health Medical Consultant to determine the specific qualifying diagnoses for which this procedure is insured.
When to Use
- Use Z426 specifically for the infusion of harvested bone marrow into a recipient as part of a transplant procedure.
- Use this code in conjunction with Z425 when the same physician team is responsible for both the aspiration from the donor and the infusion into the recipient.
Common Pitfalls
- Billing Z426 without prior confirmation from a Ministry of Health Medical Consultant regarding the patient's specific diagnosis, which leads to automatic claim rejection.
- Assuming Z426 is a standalone procedure fee without verifying if the underlying condition is currently recognized as an insured benefit under the Schedule.
- Failing to document the specific clinical indication for the transplant, which is required to justify the pre-authorization status of the procedure.
Billing Tips
- Ensure that all age-based premiums (e.g., AGE_PREMIUM_LT16Y) are applied correctly to the Z426 fee if the recipient meets the specific age criteria.
- If a surgical assistant is required, you must obtain and retain authorization from a Medical Consultant and submit the claim with the required documentation to avoid rejection.
Effective: April 1, 2025
R. Haematic and Lymphatic Surgical Procedures
HAEMATIC AND LYMPHATIC SURGICAL PROCEDURES
Surgical
Haematic and Lymphatic Surgical Procedures
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