Z495 – Follow up of unsatisfactory colonoscopy
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service covers a follow-up colonoscopy to the sigmoid or descending colon. It is only payable when a preceding colonoscopy was deemed technically unsatisfactory. The criteria for an unsatisfactory examination include poor bowel preparation, failure to intubate the cecum, or the inability to complete the examination for other technical reasons. The anaesthesia service is calculated using 5 basic units, but per the note on page , time units and anaesthesia extra units () are not payable. This code is mutually exclusive with other colonoscopy codes (e.g., Z491 to Z555) on the same day for the same patient.
When to Use
- Use Z495 when a previous colonoscopy was aborted or incomplete due to poor bowel preparation, preventing adequate visualization of the colon.
- Use Z495 when technical limitations, such as an inability to intubate the cecum or anatomical challenges, necessitated a repeat procedure to complete the examination.
Common Pitfalls
- Billing Z495 alongside other colonoscopy codes like Z491 or Z555 on the same day will result in an automatic rejection due to mutual exclusivity.
- Attempting to bill time units or extra units (GP97) for anaesthesia services with Z495 will lead to payment recovery, as these are explicitly disallowed under S17.
- Submitting E003C for supportive care/monitoring by an anaesthesiologist is prohibited for this code and will be rejected.
Billing Tips
- When billing anaesthesia for Z495, restrict the claim to the 5 basic units only, as time units and extra units are strictly non-payable.
- Ensure the clinical record clearly justifies the 'unsatisfactory' nature of the prior examination to support the use of Z495 over standard diagnostic colonoscopy codes.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures, Diagnostic and Therapeutic Procedures
Only one of Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 is eligible for payment per patient per day.
Time units and anaesthesia extra units listed on are not eligible for payment with anaesthesia services for Z491C, Z492C, Z493C, Z494C, Z495C, Z496C, Z497C, Z498C, Z499C or Z555C.
E003C is not payable for anaesthesia services rendered for Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555.
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