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Z501
Z501 – Biopsy
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Biopsy of the oral cavity and pharynx. The service includes biopsy of the nasopharynx, oropharynx, or hypopharynx. This fee is for the procedure performed without general anaesthesia. If general anaesthesia is required, claim Z537 instead. The add-on code E542 is payable when this service is performed outside of a hospital setting.
When to Use
- Use Z501 for a diagnostic biopsy of the nasopharynx, oropharynx, or hypopharynx performed under local anaesthesia in an office or clinic setting.
- Use Z501 when performing a targeted tissue sampling of an oral cavity lesion where no general anaesthetic is required, distinguishing it from the Z537 procedure.
Common Pitfalls
- Billing Z501 alongside Z537 is a common rejection error; these are mutually exclusive, and Z537 must be used exclusively if general anaesthesia is administered.
- Failing to append E542 when the biopsy is performed in a physician's office results in an automatic loss of the $12.65 out-of-hospital premium.
- Misidentifying the procedure as a simple excision; Z501 is specifically for biopsy, and using it for definitive lesion removal may be flagged during an audit.
Billing Tips
- Always verify the setting code on your claim; the E542 premium is only payable when the service location is explicitly coded as an office or non-hospital facility.
- If the patient is under 16 years of age, ensure the appropriate age premium is applied to the Z501 base fee to maximize the claim value.
Provider Fee$35.50
Effective: April 1, 2025
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
To include nasopharynx, oropharynx, hypopharynx except where otherwise specified.
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