Z444 – Insertion of permanent endocardial electrode and implantation of pack
OHIP Psychiatric Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
This service, Z444, covers the insertion of a permanent endocardial electrode and the implantation of the associated pacemaker pack. The fee for this procedure is inclusive of the insertion of a temporary transvenous lead when it is performed by the same surgeon during the same surgical session.
When to Use
- Use Z444 for the primary implantation of a permanent single or dual-chamber pacemaker system including the endocardial lead placement.
- Use this code when the procedure includes the insertion of a temporary transvenous lead, as this is bundled into the Z444 fee and cannot be billed separately.
Common Pitfalls
- Billing Z444 in conjunction with Z433 or Z445 for the same session is a common error, as these codes are mutually exclusive for the same lead/pack implantation.
- Attempting to bill a separate fee for the temporary transvenous lead insertion will result in a rejection, as it is explicitly inclusive to Z444.
Billing Tips
- Ensure the surgical assistant fee is billed using Z444B, which utilizes a specific time-based unit calculation rather than a flat percentage of the primary surgeon's fee.
Effective: April 1, 2025
Q. Cardiovascular Surgical Procedures
CARDIOVASCULAR SURGICAL PROCEDURES
Surgical
Cardiovascular Surgical Procedures
A surgical assistant's fee (Z444B) is calculated based on 6 basic units plus time units. Time units are calculated as 1 unit per 15-minute period for the first hour, 2 units per 15-minute period after the first hour up to and including the first 1.75 hours, and 3 units per 15-minute period after 1.75 hours. Refer to - for details.
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