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Z497
Z497 – Confirmatory colonoscopy - sigmoid to descending colon
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Z497 is a confirmatory colonoscopy of the sigmoid to descending colon. This procedure is eligible for payment only when rendered for a patient who has received a positive result from one of the following preliminary tests: - Faecal occult blood test(s) or faecal immunochemical test(s) (FIT) - Sigmoidoscopy - Barium enema - CT abdomen/pelvis or CT colonography examination(s)
When to Use
- Use Z497 when performing a confirmatory colonoscopy specifically for a patient who has a documented positive FIT, sigmoidoscopy, barium enema, or CT colonography.
- Use this code when the examination scope is limited to the sigmoid and descending colon following an abnormal preliminary screening result.
Common Pitfalls
- Billing Z497 alongside Z580 is a direct violation; these codes are mutually exclusive for the same patient on the same day.
- Attempting to claim an assistant fee for this procedure will result in rejection as the code is designated 'Asst: nil'.
Billing Tips
- Ensure the positive preliminary test result is clearly referenced in the patient record to justify the confirmatory nature of the procedure.
- When anaesthesia is required, bill E032C to capture the 4 basic units plus time units, as this overrides standard basic unit calculations for Z497.
Provider Fee$51.95
Anaesthetist Fee$77.45
Non-Anaesthetist Fee$77.45
Effective: April 1, 2025
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures, Diagnostic and Therapeutic Procedures
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