Z555 – Absence of signs or symptoms or risk factors, 50 years of age or older - sigmoid to descending colon
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A colonoscopy procedure from the sigmoid to descending colon, categorized under services for diagnosis or ongoing management. This procedure is specifically for patients 50 years of age or older who present with an absence of signs, symptoms, or risk factors. Payment for Z555 is subject to a frequency limit; it is considered an uninsured service if performed for the same patient within the 10-year period following a previous Z555.
When to Use
- Use Z555 for asymptomatic routine screening colonoscopies in patients aged 50 or older where the examination is limited to the sigmoid and descending colon.
- Select Z555 when the patient has no personal or family history of colorectal cancer or polyps, distinguishing it from diagnostic codes like Z491-Z499 which are reserved for symptomatic patients or those with specific risk factors.
Common Pitfalls
- Billing Z555 within 10 years of a previous Z555 claim will trigger an automatic rejection as the service is considered uninsured for that interval.
- Attempting to bill Z555 alongside any of the Z491-Z499 series on the same day will result in a rejection, as only one of these codes is payable per patient per day.
Billing Tips
- Ensure that if anaesthesia services are provided during the procedure, they are claimed using E032C to remain eligible for the time and extra units defined in GP97.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures, Anaesthesiologists' Services
50 years of age or older
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