Z461 – Mitral valvuloplasty for rheumatic stenosis
OHIP Psychiatric Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Z461 is a therapeutic procedure for mitral valvuloplasty in cases of rheumatic stenosis. The fee for this service is inclusive of angiography, whether performed with or without pressure measurements.
When to Use
- Use Z461 specifically for percutaneous or surgical mitral valvuloplasty when the primary indication is rheumatic mitral stenosis.
- Choose Z461 over general valvuloplasty codes when the rheumatic etiology is confirmed, as it is the designated code for this specific pathology.
Common Pitfalls
- Do not bill separately for angiography or pressure measurements performed during the procedure, as these are explicitly included in the Z461 fee.
- Avoid using Z461 for mitral regurgitation or non-rheumatic stenosis, as this will lead to claim rejections or audit flags for incorrect diagnosis coding.
Billing Tips
- Ensure the rheumatic stenosis diagnosis is clearly documented in the operative report to satisfy the requirements of section J11.
- If the procedure is performed on a pediatric patient, remember to apply the appropriate age premium (e.g., AGE_PREMIUM_UNDER_16_YEARS) to the base fee to maximize your claim.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Surgical Procedure
Diagnostic and Therapeutic Procedures, Cardiovascular Surgical Procedures
The patient's permanent medical record must be maintained appropriately, establishing that the service was provided, that the claim matches the service rendered, and that the service was medically necessary as per .
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