Z511 – Dilation and/or probing of duct
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Dilation and/or probing of a salivary duct, a surgical procedure listed under the 'Reconstruction' subcategory for Salivary Glands and Ducts in the Digestive System section of the Schedule. As a surgical procedure, it is eligible for surgeon (suffix A) and anaesthetist (suffix C) fees. The anaesthesia service includes 6 base units plus time units as defined in the General Preamble (). The service is not eligible for a surgical assistant fee.
When to Use
- Use Z511 for the mechanical dilation or probing of a salivary duct (e.g., Wharton's or Stensen's duct) to relieve a stricture or facilitate the passage of a sialolith.
- Use this code when performing a standalone diagnostic or therapeutic probing procedure that does not involve a formal incision or excision of the gland.
Common Pitfalls
- Billing Z511 in conjunction with a more extensive procedure on the same duct (such as a sialadenectomy or ductal reconstruction) will result in a rejection for unbundling.
- Attempting to bill a surgical assistant fee (suffix B) is a common error, as Z511 is explicitly ineligible for assistant coverage under the Schedule.
- Failing to document the specific duct involved and the clinical indication for the probing often leads to audit recovery, as this code is frequently scrutinized for medical necessity.
Billing Tips
- If the procedure is performed on a patient under 16, ensure the appropriate age premium is applied to the surgeon's fee (suffix A) to maximize the claim value.
- When Z511 is performed as part of a larger surgical session, ensure the anaesthetist bills the base units associated with the major procedure, not Z511, per GP93.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
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