Z526 – Biopsy - incisional - by gastrostomy
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
An incisional biopsy of the stomach performed by accessing the organ through a gastrostomy. This is a surgical procedure listed under the Digestive System section of the OHIP Schedule of Benefits.
When to Use
- Use Z526 when performing an incisional biopsy of the stomach specifically through an existing or newly created gastrostomy opening.
- Select Z526 for tissue sampling when the approach is limited to the gastrostomy site, distinguishing it from more extensive gastric resections or procedures coded under the Z533 series.
Common Pitfalls
- Do not bill Z526 in conjunction with a primary gastrostomy procedure code if the biopsy is considered an integral part of the surgical approach; ensure the biopsy is a distinct clinical necessity.
- Avoid billing Z526 if the procedure is performed endoscopically, as endoscopic biopsies fall under different fee codes within the Digestive System section.
Billing Tips
- If an assistant is required, you must submit the claim with suffix B and include a letter of justification for M400B to the medical consultant for manual review.
- Ensure the operative report clearly documents the gastrostomy approach to justify the use of Z526 over other general gastric biopsy codes.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Anaesthesia (suffix C) is payable on an independent consideration basis. The amount is calculated by adding the appropriate time units to the basic units listed for a comparable procedure (taking into account the region, modifying conditions, or techniques). See .
Assistant (suffix B) services are not directly payable with this code. When an assistant is required for a procedure with no listed assistant or anaesthesia units, the service may be claimed as M400B. This requires authorization by a medical consultant following submission of a letter from the surgeon outlining the reason the assistant was required. See .
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