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Z591
Z591 – Paracentesis with therapeutic drainage
OHIP Psychiatric Code — DIGESTIVE SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Paracentesis with therapeutic drainage with or without diagnostic sample is a surgical procedure involving the aspiration of fluid from the peritoneal cavity. This service is performed for therapeutic drainage purposes and may optionally include the collection of a fluid sample for diagnostic testing. As per , the phrase 'with or without' indicates that obtaining a diagnostic sample is an included but optional component of the service.
When to Use
- Use Z591 when performing a therapeutic paracentesis to relieve symptomatic ascites, regardless of whether a diagnostic fluid sample is also sent to the lab.
- Use Z591 for repeat drainage procedures in patients with chronic refractory ascites, as the code explicitly covers the therapeutic intent.
Common Pitfalls
- Do not bill Z591 in conjunction with Z590 (diagnostic paracentesis); Z591 is inclusive of any diagnostic sampling performed during the therapeutic procedure.
- Avoid billing a separate office visit fee (e.g., A007) on the same day as Z591 unless you provide a separate, unrelated service that is clearly documented as distinct from the procedure.
- Failure to document the specific therapeutic intent (e.g., relief of abdominal distension or respiratory compromise) can lead to audit scrutiny regarding the medical necessity of the procedure.
Billing Tips
- If the procedure is performed in an office or clinic setting, ensure you append the E542 add-on code to capture the additional $11.55 fee for non-hospital settings.
- If you are administering a sclerosing agent or chemotherapy during the drainage, remember to bill E724 as a separate line item to capture the additional $23.25 fee.
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