Z554 – Liver incision
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
An incisional biopsy of the liver, as listed in the Digestive System section of the Schedule of Benefits. This procedure involves surgically obtaining a tissue sample from the liver for diagnostic purposes. As a surgical procedure with a 'Z' prefix, specific rules for admission assessments apply if the patient was assessed for the same illness by the surgeon prior to admission (, ). The service is eligible for age-based premiums for patients under 16 years () and after-hours procedure premiums (E409, E410) when non-elective ().
When to Use
- Use Z554 when performing a surgical incisional biopsy of the liver to obtain tissue for diagnostic purposes.
- Select Z554 for liver tissue sampling that does not meet the criteria for more extensive procedures like a formal liver resection (S265-S275 series).
Common Pitfalls
- Billing Z554 in conjunction with a cholecystectomy when the biopsy involves liver segments #4 or #5, which is explicitly prohibited by the Schedule of Benefits.
- Failing to account for the 'Z' prefix rules; if you performed a pre-admission assessment for the same condition, you cannot bill a separate consultation or assessment code on the day of the procedure.
Billing Tips
- Ensure that if the procedure is non-elective and performed after hours, you append E409 or E410 to the claim to capture the appropriate procedural premium.
- Always verify the patient's age at the time of the procedure to automatically apply the correct percentage-based age premium (GP64) to the base fee.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Cholecystectomy is not eligible for payment in conjunction with liver lobectomy involving liver segments #4 and/or #5, or formal anatomic resection involving liver segments #4 and/or #5.
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