Z527 – Gastroscopy
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Gastroscopy is an endoscopic examination of the oesophagus, stomach, and duodenum. This service fee includes the performance of any necessary biopsies, photography, and the removal of polyps that are 1 cm or smaller in diameter.
When to Use
- Use Z527 for standard diagnostic gastroscopy where biopsies are taken or polyps 1 cm or smaller are removed, as these are included in the base fee.
- Choose Z527 when performing a routine upper endoscopy for indications such as dyspepsia, GERD, or surveillance, provided no snare polypectomy of a polyp > 1 cm is performed.
Common Pitfalls
- Attempting to bill Z292 (laryngoscopy) alongside Z527 will result in automatic rejection unless you provide a written explanation for suspected laryngeal disease for manual review.
- Billing E675 without first billing E674 is a common error; E674 must be claimed for the first polyp > 1 cm before additional E675 units are eligible for payment.
- Assuming that polyp removal is an extra procedure; removals of polyps 1 cm or smaller are considered part of the Z527 base fee and cannot be billed separately.
Billing Tips
- Always ensure that if you perform a snare polypectomy on a polyp > 1 cm, you append E674 to the Z527 claim to receive the additional $142.40 flat fee.
- If multiple polyps > 1 cm are removed, you may claim E674 once and E675 up to two times, provided all polyps removed were > 1 cm.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Z292 rendered in association with gastroscopy services is not eligible for payment unless the laryngoscopy service is rendered for suspicion of disease of the larynx. Claims for Z292 in these circumstances are assessed by a medical consultant on a manual review basis and require the submission of a written explanation.
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