Z571 – Excision of first polyp (3 mm to 5 mm)
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service is for the excision of the first polyp found during a procedure, where the polyp size is between 3 mm and 5 mm. Billing Instructions: - When multiple polyps of different sizes are excised, the fee for the largest polyp excised should be claimed as the 'first polyp' service. For example, if polyps of 4mm, 8mm, and 12mm are removed, the 12mm polyp would be billed using Z517, and the other two would be claimed using the appropriate 'each additional polyp' codes. - Excision of polyps smaller than 3 mm is not eligible for payment.
When to Use
- Use Z571 as the primary code when the largest polyp removed during a colonoscopy measures between 3 mm and 5 mm.
- Use Z571 in conjunction with E720 when you excise one 4 mm polyp and one additional 3 mm polyp in the same session.
Common Pitfalls
- Claiming Z571 when a larger polyp (e.g., 8 mm) is also removed; the largest polyp must dictate the primary code (e.g., Z517), with Z571 or E720 potentially used for the smaller ones.
- Billing Z571 for polyps smaller than 3 mm, which are considered non-billable and will result in claim rejection.
- Exceeding the maximum of two 'additional polyp' add-on codes (E720, E520, E519, or E518) per patient per day.
Billing Tips
- Always identify and measure all polyps before billing to ensure the largest one is assigned the correct primary code (Z571, Z518, Z517, or Z516).
- Ensure the total count of add-on codes for additional polyps does not exceed two, regardless of how many polyps beyond the first were removed.
Effective: April 1, 2025
S. Digestive System Surgical Procedures
DIGESTIVE SYSTEM SURGICAL PROCEDURES
Procedure
Digestive System Surgical Procedures
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