Z565 – Complete haemorrhoidectomy using cryotherapy and/or Barron ligation(s) including rectal dilation
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Z565 is for a complete haemorrhoidectomy performed using cryotherapy and/or Barron ligation(s), and includes rectal dilation. Payment Rules: This procedure is only insured when the patient meets the following criteria: - a. has failed a trial of non-surgical therapy; AND - b. has Grade III or IV haemorrhoids; OR - c. has haemorrhoids with substantial concomitant skin tags. Note on '#' Prefix: This service is denoted with a '#' prefix. As per , when this service is performed in a hospital, the premises, equipment, supplies, and personnel are funded by the hospital's global budget. If rendered in an Integrated Community Health Services Centre (ICHSC), these costs are funded by the ICHSC. Patients cannot be charged for these items if the service is rendered outside of a hospital or ICHSC.
When to Use
- Use for patients with symptomatic Grade III or IV haemorrhoids who have failed conservative management such as fiber supplementation, stool softeners, or topical therapies.
- Use for patients presenting with haemorrhoids accompanied by significant, symptomatic skin tags that require excision or ligation during the same procedure.
Common Pitfalls
- Billing Z565 for Grade I or II haemorrhoids is a common audit trigger; these lower grades are typically managed with office-based procedures not covered under this code.
- Failure to document the failure of non-surgical therapy in the patient record is a frequent reason for claim rejection or clawback during an audit.
- Attempting to bill Z565 in conjunction with other haemorrhoid procedures (e.g., S247) without clear clinical justification for separate procedures can lead to payment denials.
Billing Tips
- Ensure your operative note explicitly states the haemorrhoid grade (III or IV) and the specific non-surgical interventions previously attempted to satisfy the S28:696 requirements.
- Since Z565 is a '#' code, ensure you are not billing for facility or tray fees, as these are strictly prohibited and covered by the hospital or ICHSC global budget.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Surgical
Digestive System Surgical Procedures
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