Z516 – Excision of first polyp (20 mm to 29 mm)
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of first polyp (20 mm to 29 mm) is a surgical procedure for the removal of a colonic polyp measuring between 20 and 29 millimeters, performed via colonoscopy. According to the claims submission instructions on page of the Schedule, the fee code for the first polyp excised should be determined by the size of the largest polyp removed. This service includes the necessary anaesthesia and is subject to specific billing rules with other polyp excision codes.
When to Use
- Use Z516 as the primary code when the largest polyp removed during a colonoscopy measures between 20 mm and 29 mm.
- Use Z516 as the base code to unlock the ability to bill additional excision codes (E518, E519, E520, or E720) for subsequent polyps removed during the same session.
Common Pitfalls
- Billing Z516 alongside Z571, Z518, or Z517 is a common error; only one primary polyp excision code is payable per patient per day based on the largest polyp size.
- Attempting to bill for the excision of polyps smaller than 3 mm will result in rejection, as these are not eligible for payment under the Schedule.
- Exceeding the maximum of two additional polyp excision services (E720, E520, E519, or E518) per patient per day will lead to partial claim rejection.
Billing Tips
- Always identify the largest polyp removed to select the correct primary code (Z571, Z518, Z517, or Z516) first, then append the appropriate additional excision codes.
- Ensure your operative report clearly documents the size of each polyp removed to support the primary code selection and the quantity of additional excision codes claimed.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
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