Z433 – Replacement of pacemaker pack
OHIP Psychiatric Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This service is for the surgical replacement of a pacemaker pack. It applies to both single and multiple lead systems. The fee for this service includes the common elements of all insured services and the specific elements for a surgical procedure as outlined in the Schedule of Benefits. As a Z-prefix procedure, an admission assessment by the surgeon is considered a specific re-assessment if the patient was assessed for the same illness prior to admission (see , ). Assistant services are eligible for payment on an independent consideration basis by claiming M400B with the number of basic units equal to the anaesthesia base units ().
When to Use
- Use Z433 for the routine surgical replacement of a pacemaker pulse generator (pack) where the existing leads remain in situ and are connected to the new device.
- Use Z433 when a patient requires a generator change due to elective end-of-life (EOL) battery depletion or elective replacement indicator (ERI) status.
- Use Z433 for generator replacements regardless of whether the system is single-chamber or dual-chamber, as the code covers both configurations.
Common Pitfalls
- Do not bill Z433 if the procedure involves the insertion or replacement of leads; those procedures require different codes such as Z444 or Z445.
- Avoid billing Z433 in conjunction with a consultation code on the same day; the Z433 fee includes the pre-operative assessment for the procedure.
- Failure to provide a letter of justification for a surgical assistant (M400B) will result in automatic rejection, as assistant services for Z433 are not automatically approved.
Billing Tips
- When claiming for a surgical assistant, use M400B and specify 6 basic units, ensuring you have a letter ready to submit to the Ministry explaining the clinical necessity for the assistant.
- If the procedure is performed after hours, ensure you append the correct E-code (E409 or E410) to the Z433 claim to receive the appropriate percentage premium on the base fee.
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