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Z528
Z528 – Gastroscopy - subsequent
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Gastroscopy - subsequent (within three months following previous gastroscopy)
When to Use
- Use Z528 for repeat gastroscopy procedures performed within three months of a previous gastroscopy on the same patient.
- Select Z528 when performing a follow-up endoscopic evaluation to monitor healing of a previously identified lesion or ulcer within the three-month window.
Common Pitfalls
- Billing Z292 (laryngoscopy) alongside Z528 will result in an automatic rejection unless you provide a written explanation confirming suspicion of laryngeal disease.
- Attempting to bill Z528 as a primary procedure when the interval from the previous gastroscopy exceeds three months is incorrect; use Z527 instead.
- Failing to link E674 and E675 correctly; E675 is only payable if E674 is also claimed for the first polyp greater than 1 cm.
Billing Tips
- Ensure E674 and E675 are only claimed for snare polypectomies of polyps exceeding 1 cm, as these add-ons are strictly defined by size and technique.
- If you require an assistant for a complex Z528 procedure, you must submit a letter to a medical consultant to authorize M400B, as assistance is not automatically payable.
Provider Fee$67.85
Anaesthetist Fee$61.96
Non-Anaesthetist Fee$61.96
Effective: April 1, 2025
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Code Classes
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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