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Z569
Z569 – Pelvic abscess, incision and drainage
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A surgical procedure involving the incision and drainage of a pelvic abscess. The approach to the abscess is performed through the rectum or vagina. This procedure is eligible for anaesthesia services, calculated with 7 base units plus time units. As a 'Z' prefix surgical procedure, it is subject to specific payment rules for admission assessments when performed on an in-hospital basis.
When to Use
- Use Z569 for the surgical drainage of a pelvic abscess specifically via the transrectal or transvaginal route.
- Use this code when the procedure is performed as a distinct surgical intervention, rather than a diagnostic aspiration or biopsy.
Common Pitfalls
- Billing Z569 alongside a full consultation or assessment code for the same admission is a common error; per the 'Z' prefix rule, the admission assessment is deemed a re-assessment.
- Failing to document the specific surgical approach (rectal or vaginal) can lead to audit scrutiny regarding the appropriateness of the Z569 code versus other pelvic surgical codes.
Billing Tips
- Ensure that if the procedure is performed after hours, you append the correct E-code (E409 or E410) to the Z569 claim to capture the 50% or 75% procedural premium.
- Remember that Z569 is eligible for anaesthesia base units (7) plus time; ensure the anaesthesiologist's claim reflects the correct start and end times to maximize the time-based units.
Provider Fee$122.05
Anaesthetist Fee$108.43
Non-Anaesthetist Fee$108.43
Effective: April 1, 2025
Category
S. Digestive System Surgical Procedures
Subcategory
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Digestive System Surgical Procedures
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