Z475 – Biopsy(ies) - sole procedure, general anaesthetic
OHIP Psychiatric Code — FEMALE GENITAL SURGICAL PROCEDURES · Schedule of Benefits
Surgical excision of one or more biopsies from the vulva and/or introitus, performed under general anaesthetic. This service is only billable when it is the sole procedure performed during the operative session. Payment for assistant and anaesthetist services are calculated based on basic and time units as outlined in the Schedule of Benefits.
When to Use
- Use Z475 when performing a vulvar or introital biopsy as the only surgical procedure during an operative session under general anaesthetic.
- Use this code when the biopsy is the primary and singular focus of the procedure, as it is strictly prohibited when combined with other surgical interventions.
Common Pitfalls
- Billing Z475 alongside any other surgical procedure code will result in an automatic rejection, as it is only payable as a sole procedure.
- Attempting to bill this code for biopsies performed under local anaesthetic or sedation is incorrect; it is specifically designated for general anaesthetic cases.
Billing Tips
- Ensure your operative report explicitly states that the biopsy was the sole procedure performed to support the claim in the event of an audit.
- If the biopsy is performed in conjunction with other procedures, you must bill the appropriate alternative surgical code, as Z475 is not applicable in multi-procedure sessions.
Effective: April 1, 2026
V. Female Genital Surgical Procedures
FEMALE GENITAL SURGICAL PROCEDURES
Surgical
Female Genital Surgical Procedures
For time-based components (assistant, anaesthesia), the start and end times of the service must be recorded in the patient's medical record. See for general requirements on documenting time-based services.
Female
when sole procedure
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