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Z544
Z544 – Biopsy
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A rectal biopsy, which is a surgical procedure to remove a small piece of tissue from the rectum for examination. This service is listed under the Incision category for the rectum.
When to Use
- Use Z544 when performing a targeted tissue biopsy of the rectum, distinct from a full excision or more complex surgical procedure.
- Use this code for a diagnostic biopsy procedure where tissue is removed specifically for pathological examination, as opposed to therapeutic removal of a lesion.
Common Pitfalls
- Do not bill Z544 in conjunction with more comprehensive rectal surgical codes (e.g., S241 or S243) if the biopsy is considered an integral part of that procedure.
- Avoid billing Z544 if the procedure is actually a simple excision of a small polyp, which may have a more specific code classification depending on the clinical findings.
Billing Tips
- Ensure the pathology report is cross-referenced with your billing date to substantiate the medical necessity of the biopsy if audited.
- If the biopsy is performed as part of an after-hours emergency, ensure the non-elective nature of the procedure is clearly documented to support the application of E409 or E410.
Provider Fee$34.90
Anaesthetist Fee$92.94
Non-Anaesthetist Fee$92.94
Effective: April 1, 2025
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
All insured services must be documented in appropriate records that establish: an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
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