Z455 – Injections of extensive keloids - under general anaesthesia
OHIP Psychiatric Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Injections of extensive keloids - under general anaesthesia. A surgical procedure identified by a 'Z' prefix, which falls under the 'Surgical Procedures' sections of the Schedule of Benefits. The complete description and clinical indications for this service are listed on page of the Schedule. The service is eligible for anaesthesia (billed as Z455C). General Rules for 'Z' Prefix Procedures: - According to , an admission assessment by a surgical specialist who has assessed the patient prior to admission for a 'Z' prefix procedure is deemed a specific re-assessment. - As a surgical procedure, it is eligible for various premiums, including age-based premiums (), after-hours premiums (), and the trauma premium ().
When to Use
- Use Z455 when performing intralesional injections for extensive keloid scarring that specifically requires the patient to be under general anaesthesia.
- Use this code for complex keloid cases where the extent of the lesions or patient tolerance necessitates a formal general anaesthetic, distinguishing it from simple office-based injections.
Common Pitfalls
- Billing Z455 for local anaesthetic procedures is an audit risk; the code explicitly requires general anaesthesia.
- Failing to link the anaesthesiologist's claim (Z455C) to the surgeon's procedure code Z455 can lead to processing delays or rejections.
- Attempting to bill a consultation or office visit code on the same day as the Z455 procedure is generally ineligible unless a separate, unrelated clinical issue is addressed and documented.
Billing Tips
- Ensure the operative report clearly justifies the necessity of general anaesthesia for the keloid injections to support the use of this specific code over standard injection codes.
- Always apply relevant age-based premiums (GP64) or after-hours premiums (E409/E410) if the procedure meets the specific timing or patient age criteria.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Surgical
Integumentary System Surgical Procedures
All insured services must be documented in appropriate records. The record must establish that: an insured service was provided; the service for which the account is submitted is the service that was rendered; and the service was medically necessary.
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