Z612 – Endoscopic urethral realignment for urethral trauma
OHIP Psychiatric Code — UROGENITAL AND URINARY SURGICAL PROCEDURES · Schedule of Benefits
This billing code represents endoscopic urethral realignment for urethral trauma. This is a surgical procedure and is eligible for surgeon (suffix A), assistant (suffix B) and anaesthesia (suffix C) services.
When to Use
- Use Z612 for the definitive endoscopic realignment of a traumatic urethral disruption, typically performed in the acute setting to restore urethral continuity.
- Select Z612 when the procedure involves the passage of a catheter or guidewire specifically as part of the endoscopic realignment process for trauma.
Common Pitfalls
- Billing Z612 alongside diagnostic cystoscopy or retrograde urethrogram is a common error that will trigger automatic rejection due to the bundled nature of these services.
- Failing to document the specific trauma mechanism and the necessity of the endoscopic approach can lead to audit recovery, as the code is strictly for trauma-related realignment.
- Attempting to claim for the insertion of a guidewire or catheter as a separate procedural fee is prohibited, as these are considered integral components of the Z612 service.
Billing Tips
- Ensure the Injury Severity Score (ISS) is clearly documented in the medical record if you intend to claim the E420 trauma premium, as this is a mandatory requirement for eligibility.
- When performing this procedure after hours, prioritize the use of E409A or E410A for the surgeon, but remember that these are mutually exclusive with the E420 trauma premium.
Effective: April 1, 2025
T. Urogenital and Urinary Surgical Procedures
UROGENITAL AND URINARY SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
Medical records must establish that an insured service was provided, the service claimed is the service that was rendered, and the service was medically necessary.
Cystoscopy, urethroscopy, retrograde urethrogram or insertion of guidewire/catheter is not eligible for payment with Z612.
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