Z856 – Chalazion, single or multiple - general anaesthetic
OHIP Psychiatric Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
This service covers the excision of a single chalazion or multiple chalazia from the eyelid, requiring the administration of a general anaesthetic. As indicated by the '#' prefix, when performed in a hospital or Integrated Community Health Services Centre (ICHSC), the cost of premises, equipment, supplies, and personnel are covered by the facility's budget and cannot be billed to the patient (). The anaesthesia component includes 6 base units plus time units. For additional guidance, see 'Appendix D Surface Pathology' ().
When to Use
- Use Z856 when a chalazion excision is performed under general anaesthesia in a hospital or ICHSC setting, as opposed to Z874 which is typically for local anaesthesia.
- Use Z856 for pediatric patients or patients with significant anxiety where general anaesthesia is medically necessary for the safe removal of a chalazion.
Common Pitfalls
- Billing Z856 in a private office setting is a violation of the '#' prefix rule, which mandates that facility costs are covered by the hospital budget.
- Failing to document the specific start and end times of the anaesthesia in the patient record is a frequent cause of audit recovery for unit-based claims.
- Attempting to bill for multiple chalazia separately; Z856 covers the excision of single or multiple chalazia, so it should only be claimed once per operative session.
Billing Tips
- Ensure the ASA physical status and any applicable extra units (e.g., E022C for ASA III) are clearly documented in the pre-operative assessment to support the anaesthesia time units claimed.
- When multiple procedures are performed under the same anaesthetic, ensure the base units are correctly aligned with the major procedure as per the payment adjustment rules.
Effective: April 1, 2025
Y. Ocular and Aural Surgical Procedures
OCULAR SURGICAL PROCEDURES
Surgical
Ocular and Aural Surgical Procedures, Anaesthesiologists' Services
For unit-based anaesthesia services, the start and end times must be recorded in the patient's permanent medical record.
If the trauma premium (E420) is claimed, the Injury Severity Score (ISS) must be listed in the medical record.
If anaesthesia extra units are claimed (e.g., E010C for BMI > 40, E022C for ASA III), the basis for the claim must be documented in the medical record. The ASA level must be determined and documented at the time of the pre-operative anaesthesia assessment.
See Appendix D Surface Pathology.
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