Z560 – Duodenoscopy
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Duodenoscopy is an endoscopic procedure to examine the duodenum. This service is part of the Digestive System Surgical Procedures section. The fee for this service includes the common and specific elements of a surgical procedure as outlined in the Schedule of Benefits. Note: This service is not to be claimed if Z399 (Gastroscopy) and/or Z400 (Gastroscopy with biopsy) were performed on the same patient within the preceding 3 months. Additionally, Z292 (Laryngoscopy) rendered in association with duodenoscopy is not eligible for payment unless the service is for suspicion of disease of the larynx, requiring manual review with a written explanation.
When to Use
- Use Z560 when performing a diagnostic duodenoscopy that is distinct from a standard gastroscopy (Z399) or gastroscopy with biopsy (Z400).
- Use Z560 as the primary procedure code when performing endoscopic stent placement in the duodenum, appending E629 as the add-on fee.
Common Pitfalls
- Claiming Z560 within 3 months of Z399 or Z400 will trigger an automatic rejection due to the established global period for upper GI endoscopy.
- Billing Z292 (Laryngoscopy) alongside Z560 will result in a rejection unless you provide a written explanation for suspected laryngeal disease, as it is not considered a standard associated procedure.
Billing Tips
- If you require an assistant for this procedure, you must submit a letter of justification to a medical consultant and bill the assistance using M400B rather than attempting to claim an assistant fee directly under Z560.
- Always verify the patient's endoscopy history for the preceding 90 days to avoid the automatic restriction associated with Z399 and Z400.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
Z292 rendered in association with duodenoscopy and small bowel push enteroscopy 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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