Z502 – Lesion - less than 2 cms
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service covers the excision of a lesion of the oral cavity or pharynx that is less than 2 cm in size. The fee for the surgeon (Z502A) is a set amount. Fees for an assistant (Z502B) and anaesthetist (Z502C) are calculated based on 6 basic units each plus time units as described in the General Preamble (, ). Related codes for larger lesions are S003 (2 to 4 cms) and S006 (over 4 cms). An additional premium, E542, is payable when the procedure is performed outside of a hospital. Note: Per , this code applies to procedures in the nasopharynx, oropharynx, and hypopharynx unless specified otherwise.
When to Use
- Use Z502 for the excision of a solitary lesion in the nasopharynx, oropharynx, or hypopharynx that measures strictly less than 2 cm.
- Use Z502 when performing a biopsy or excision in an office setting, ensuring the E542 premium is added to the claim to account for the non-hospital location.
Common Pitfalls
- Billing Z502 for lesions 2 cm or larger, which must be billed under S003 (2-4 cm) or S006 (over 4 cm) to avoid rejection or audit recovery.
- Failing to document the exact size of the lesion in the operative report, which is the primary metric for justifying the code selection during an audit.
- Attempting to bill a full consultation code in addition to Z502 for a hospital admission, which is restricted by the General Preamble rules regarding surgical specialist assessments.
Billing Tips
- Always append the E542 premium when the excision is performed in a physician's office or clinic to capture the additional $11.55 fee.
- Ensure that if an assistant or anaesthetist is involved, their claims are submitted with the appropriate time units and base units (6) to correctly trigger the calculated fee.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
To include nasopharynx, oropharynx, hypopharynx except where otherwise specified.
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