Z517 – Excision of first polyp (10 mm to 19 mm)
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Excision of the first polyp measuring between 10 mm and 19 mm. Per payment rules on page , the largest polyp excised should be used to determine the appropriate fee code to claim for the first polyp from the group Z571, Z518, Z517 or Z516. Excision of polyps smaller than 3mm is not an eligible service.
When to Use
- Use Z517 as the primary code when the largest polyp removed during the procedure measures between 10 mm and 19 mm.
- Use Z517 when performing a polypectomy on a patient where the single largest lesion falls within the 10-19 mm range, regardless of the size of any additional smaller polyps removed.
Common Pitfalls
- Billing Z517 in combination with Z571, Z518, or Z516 is a common error; only one of these codes is payable per patient per day based on the largest polyp size.
- Attempting to bill for the excision of polyps smaller than 3 mm is not permitted and will result in claim rejection.
- Exceeding the maximum of two add-on services (E720, E520, E519, or E518) per patient per day will lead to partial payment denial.
Billing Tips
- Always identify and measure the largest polyp first to select the correct base code (Z571, Z518, Z517, or Z516) before calculating add-on codes.
- Ensure that any additional polyps in the 10-19 mm range are billed using the add-on code E519 to maximize the claim value up to the daily limit.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Payment rule: Only one of Z571, Z518, Z517 or Z516 is eligible for payment per patient per day.
Payment rule: A maximum of 2 services of any combination of E720, E520, E519, or E518 are eligible for payment per patient per day.
Payment rule: Excision of polyps <3mm is not eligible for payment.
The related colonoscopy codes Z497, Z499, Z492, Z493, Z496, Z494, Z498, Z495, Z491, and Z555 include fulguration, if performed.
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