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Z465

Z465Device closure of a single defect

OHIP Psychiatric Code — CARDIOVASCULAR SURGICAL PROCEDURES · Schedule of Benefits

Percutaneous transluminal catheter assisted closure for Secundum atrial septal defect, which involves the closure of a single defect using a device.

When to Use

  • Use Z465 specifically for the percutaneous closure of a single Secundum atrial septal defect using a device.
  • Select Z465 when the procedure is performed via catheter-assisted technique, distinguishing it from open surgical repair codes.

Common Pitfalls

  • Billing Z465 and Z466 for the same patient on the same day by the same physician will result in a rejection, as the Schedule limits payment to two services only when performed by two different physicians.
  • Failure to apply the appropriate age premium for pediatric patients under 16 years old results in significant under-billing of the procedural fee.

Billing Tips

  • Ensure the claim includes the correct age premium code if the patient is under 16, as this is a percentage-based increase applied to the base fee of $198.55.
  • If the procedure is non-elective and performed after hours, verify eligibility for E409 or E410, but note that these cannot be combined with the E420 trauma premium.
Provider Fee$198.55

Effective: April 1, 2025

Category

Q. Cardiovascular Surgical Procedures

Subcategory

CARDIOVASCULAR SURGICAL PROCEDURES

Service Type

Surgical

Code Classes

Cardiovascular Surgical Procedures

A maximum of 2 services of either Z465 or Z466 are eligible for payment if the services are rendered by 2 different physicians, same patient same day.

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