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Z854
Z854 – Drainage of abscess - local anaesthetic
OHIP Psychiatric Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Drainage of an abscess of the eyelid under local anaesthetic. This is a surgical procedure listed under the 'Ocular and Aural Surgical Procedures' section of the Schedule of Benefits. The corresponding service performed under general anaesthetic is Z855.
When to Use
- Use Z854 for the incision and drainage of an eyelid abscess performed exclusively under local anaesthetic in an office or clinic setting.
- Select Z854 when the procedure is limited to the eyelid; do not use this code for abscesses located on the cheek or other facial areas, which fall under different surgical fee schedules.
Common Pitfalls
- Billing Z855 instead of Z854; Z855 is strictly reserved for drainage performed under general anaesthetic and will be rejected if the procedure note confirms only local anaesthetic was used.
- Attempting to bill a separate office visit fee (e.g., A007) on the same day as Z854; the surgical fee for Z854 is considered comprehensive and includes the assessment related to the procedure.
Billing Tips
- If the patient is under 16 years of age, ensure you apply the appropriate age-based surgical premium to the $60.00 base fee to maximize the claim value.
- If the procedure is performed on an emergency basis after hours, verify eligibility for E409 or E410, as these premiums are calculated as a percentage of the Z854 base fee.
Provider Fee$60.00
Effective: April 1, 2025
Category
Y. Ocular and Aural Surgical Procedures
Subcategory
OCULAR SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Ocular and Aural Surgical Procedures
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