Z521 – Sialolithotomy requiring general anaesthesia
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Sialolithotomy - requiring general anaesthesia is a surgical procedure for the removal of a stone from a salivary gland or duct. This code is used when the procedure is complex enough to necessitate general anaesthesia. It is an extension of code Z500 (Sialolithotomy). The fee for this service includes the surgical procedure itself. Assistant (<suffix>B</suffix>) and anaesthesia (<suffix>C</suffix>) services are billed separately and are calculated based on basic and time units.
When to Use
- Use Z521 when the sialolithotomy is performed in a hospital setting specifically requiring general anaesthesia, distinguishing it from the office-based or local anaesthesia procedure Z500.
- Use Z521 for complex salivary duct stones where the anatomical location or patient tolerance necessitates general anaesthesia to ensure safe and complete removal.
Common Pitfalls
- Billing Z521 when the procedure was performed under local anaesthesia or sedation; this is a common audit trigger as Z521 explicitly requires general anaesthesia.
- Failing to bill the assistant (Z521B) or anaesthesia (Z521C) as separate line items, as these are not included in the $103.60 procedural fee.
Billing Tips
- Ensure the anaesthesia record clearly documents the use of general anaesthesia to support the use of Z521 over Z500 during a potential audit.
- If the procedure is non-elective and performed after hours, remember to append the appropriate E-series premium (E409 or E410) to the procedural fee to maximize reimbursement.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
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