All codes
Z862
Z862 – Dacryocystotomy - general anaesthetic
OHIP Psychiatric Code — OCULAR SURGICAL PROCEDURES · Schedule of Benefits
Dacryocystotomy is a surgical procedure involving an incision into the lacrimal sac. This service requires general anaesthesia. The surgeon's fee is for the surgical procedure itself (Z862A). The anaesthetist's fee (Z862C) is calculated based on 6 base units plus time units as per the rules outlined in the Schedule of Benefits (see , ).
When to Use
- Use Z862A specifically for surgical incision of the lacrimal sac requiring general anaesthesia, distinguishing it from office-based lacrimal procedures that do not involve general anaesthesia.
- Use this code for non-elective dacryocystotomy cases where the procedure is performed in an operating room setting under general anaesthesia.
Common Pitfalls
- Attempting to bill a special visit premium (e.g., A900) directly with Z862A; these premiums must be linked to the associated pre-operative consultation or assessment, not the surgical code itself.
- Incorrectly billing for a surgical assistant; Z862A does not allow for an assistant fee unless specifically authorized, in which case M400B must be used with the base units set to 6.
- Failing to document the Injury Severity Score (ISS) when attempting to claim the E420 trauma premium, which is a frequent cause of audit-related clawbacks.
Billing Tips
- Ensure the anaesthetist's claim (Z862C) is submitted with the correct base units (6) plus time units, and verify that any applicable after-hours premiums (E400C or E401C) are applied to the total anaesthetic fee, not just the base units.
- If the patient is under 30 days of age, remember to apply the 30% age-based premium to the Z862A procedural fee to ensure accurate reimbursement.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.