Z535 – Sigmoidoscopy with rigid scope
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Sigmoidoscopy with or without anoscopy performed using a rigid scope. This is a surgical procedure for examining the rectum and sigmoid colon. The service is listed in the Digestive System section of the Schedule of Benefits. The anaesthesia component of this service is calculated using base units plus time units.
When to Use
- Use Z535 for a diagnostic rigid sigmoidoscopy where no tissue biopsy is taken.
- Use Z535 when performing a rigid sigmoidoscopy for the purpose of visual inspection of the rectum and sigmoid colon in an office or hospital setting.
Common Pitfalls
- Billing Z535 alongside Z555 or Z580 is strictly prohibited and will trigger a rejection.
- Failing to document the start and end times for the procedure is a common audit failure, especially when claiming associated anaesthesia units.
- Incorrectly billing Z535 when a biopsy is performed; Z536 must be used instead when tissue is sampled.
Billing Tips
- Always append the E746 premium if the procedure is performed in a non-hospital setting to capture the additional $5.85 fee.
- Ensure that if you are managing uncomplicated GI bleeding during the procedure, you include the E797 add-on code to increase the claim by $46.30.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures, Diagnostic and Therapeutic Procedures
All insured services must be documented in appropriate records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary. (See )
For unit-based anaesthesia services, the physician must record on the patient's permanent medical record or chart the time when the insured service started and ended. (See )
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