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Z445
Z445 – Repositioning of permanent endocardial electrode
OHIP Psychiatric Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits
Repositioning of permanent endocardial electrode (as separate procedure). This is a surgical service that includes the repositioning of a permanent pacemaker lead. The note specifies this service is claimed when it is performed as a separate procedure and not in conjunction with other pacemaker services such as initial insertion or pack replacement. The service fee includes the surgeon's work and associated pre-operative and post-operative care as defined in the .
When to Use
- Use Z445 when a lead dislodgement or sensing/capture failure is identified post-operatively and requires surgical repositioning as a standalone procedure.
- Use this code for isolated lead revisions where no other pacemaker system components are replaced or upgraded during the same operative session.
Common Pitfalls
- Billing Z445 on the same day as initial insertion codes Z444 or Z435 will result in an automatic rejection as these are mutually exclusive.
- Attempting to bill Z445 alongside generator replacements or other system upgrades is a common audit trigger, as Z445 is strictly defined as a separate procedure.
Billing Tips
- Ensure the operative note explicitly details the repositioning of the endocardial electrode to justify the claim as a standalone surgical service.
- If the procedure is performed after hours or on weekends for non-elective reasons, apply the appropriate E409 or E410 premium to the Z445 fee to maximize reimbursement.
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