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Z861
Z861 – Biopsy of conjunctiva
OHIP Psychiatric Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Z861 is listed under the Ocular and Aural Surgical Procedures section and involves performing a biopsy on the conjunctiva. This service is eligible for surgeon (suffix A) and anaesthetist (suffix C) fees. The anaesthesia service is allocated 6 base units.
When to Use
- Use Z861 for a formal tissue biopsy of the conjunctiva where the specimen is sent for histopathological examination.
- Use Z861 when performing a diagnostic biopsy for suspected malignancy or chronic inflammatory conditions, distinct from simple excision of a lesion (e.g., E208 or E210).
Common Pitfalls
- Do not bill Z861 for the simple excision of a conjunctival cyst or papilloma; those procedures have their own specific codes and Z861 is strictly for biopsy.
- Avoid billing Z861 in conjunction with other ocular surgical procedures on the same site unless the biopsy is a distinct, separate diagnostic event from the primary procedure.
Billing Tips
- Ensure the pathology report is available to support the claim, as Z861 specifically implies the collection of tissue for diagnostic analysis.
- If the biopsy is performed under general anaesthesia, ensure the anaesthetist is aware that the 6 base units for Z861 apply to the anaesthesia claim.
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