E003

PDF page 104 / GP90

SECOND ASSISTANT
Payment rules:
When more than one assistant was required for a surgical procedure, unless the service is listed
below, the second assistant’s service is only eligible for payment following authorization by a medical
consultant and requires submission of a letter from the surgeon outlining the reason the second
assistant was required. The amount payable for the second assistant is calculated in the same
manner as the amount payable for the first assistant.
Services where a second assistant's services are payable and authorization is not required:
D043, D046, D047, D052, D060, E645, F135, M112, M117, M134, M142, N539, N540, P042, P051,
P052, P056, P059, R008, R009, R013, R014, R015, R016, R055, R056, R064, R065, R067, R069,
R134, R135, R136, R140, R182, R240, R241, R244, R326, R327, R334, R393, R438, R440, R441,
R483, R487, R545, R553, R568, R593, R594, R617, R645, R701, R702, R704, R712, R713, R714,
R715, R718, R726, R727, R728, R729, R732, R733, R734, R735, R737, R739, R742, R743, R746,
R747, R749, R764, R770, R771, R772, R773, R774, R786, R799, R800, R801, R802, R803, R804,
R811, R815, R817, R818, R830, R832, R858, R863, R870, R872, R874, R876, R927, R929, R920,
R930, S005, S007, S079, S090, S091, S092, S096, S098, S099, S120, S125, S189, S210, S211,
S213, S214, S267, S270, S271, S274, S275, S294, S295, S298, S300, S321, S416, S429, S440,
S441, S453, S454, S462, S484, S750, S757, S758, S759, S816
       [Commentary:
       E003B is not eligible for payment for second assistant services.]

PDF page 116 / GP102

CALCULATION OF FEE PAYABLE
  The fee for this service is calculated in the same manner as for assistant and anaesthesia services.
                                                                                                             Asst                        Anae
               E003 Supportive care/Monitoring ....................................................           6                           4
                                          Payment rules:
                                          1.For E003B, the assistants’ premiums apply as for assistants’ services.
                                          2.Anaesthesia extra units listed on GP97 are not eligible for payment with E003C.
                                          3.E003B is not eligible for payment for second assistant services.

PDF page 697 / S15

DIGESTIVE SYSTEM SURGICAL PROCEDURES
      INTESTINES (EXCEPT RECTUM)
                                                                                                           Asst      Surg      Anae
      ENDOSCOPY
  # Z560 Duodenoscopy (not to be claimed if Z399 and/or Z400
           performed on same patient within 3 months) .....................                                           92.10     4
  # Z749 Subsequent procedure (within three months following previous
           endoscopic procedure).......................................................                               72.55     4
  # E629   - endoscopic placement of stent in duodenum............. add                                              137.05
  # Z584 Small bowel push enteroscopy ...............................................                   185.15
  # E797     - management of uncomplicated upper or lower
               gastrointestinal bleeding, by any technique (e.g. laser,
               injection, diathermy, banding etc.) to Z584 ................ add                          46.30
  # E798     - management of complicated upper gastrointestinal
               bleeding by any technique in haemodynamically unstable
               patients with active bleeding during endoscopy, to Z584
                ................................................................................... add  69.70
  # Z588 Double Balloon enteroscopy...................................................                   50.00
  # E250     - surgical time, to Z588
                ................................ per 15 minutes or major part thereof                   100.00
        Note:
        1.Z292 rendered in association with duodenoscopy and small bowel push enteroscopy
          services is not eligible for payment unless the laryngoscopy service is rendered for suspicion
          of disease of the larynx. Claims for Z292 in these circumstances are assessed by a medical
          consultant on a manual review basis and require the submission of a written explanation.
        2.Z588 is an all-inclusive fee code. With the exception of E250, no other surgical or procedural
          services are eligible for payment when Z588 is eligible for payment.
        3.Time units are calculated based on the time spent by the physician in direct contact with the
          patient for the purpose of the procedure. Time commences when the physician is first in
          attendance with the patient in the operating/procedure room and ends when the physician is
          no longer in attendance with that patient in the operating/procedure room.
                                          [Commentary:
                                          Manual review is not required for Z293, Z322 and Z323 rendered in association with
                                          duodenoscopy and small bowel push enteroscopy services.]
  # Z512 Endoscopy of ileostomy or colostomy, or reduction of
           obstructed Koch ileostomy .................................................                                36.80     4
  # E747   - to cecum .................................................................... add                        31.15
  # Z514 - with biopsy..........................................................................                      44.55     4
      SIGMOIDOSCOPY
  # Z580 Sigmoidoscopy (using 60 cm. flexible endoscope).................    nil       57.70      5
        Note:
        1.Z580 is not eligible for payment with Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499
          or Z555 same patient same day.
        2.For sigmoidoscopy with rigid scope, see Z535 (Rectum).
        3.Time units and anaesthesia extra units listed on GP97 are not eligible for payment with
          anaesthesia services for Z580C.
        4.E003C is not payable for anaesthesia services rendered for Z580.

PDF page 700 / S18

DIGESTIVE SYSTEM SURGICAL PROCEDURES
INTESTINES (EXCEPT RECTUM)
                                                                           Asst      Surg      Anae
     2.Time units and anaesthesia extra units listed on GP97 are not eligible for payment with
        anaesthesia services for Z491C, Z492C, Z493C, Z494C, Z495C, Z496C, Z497C, Z498C,
        Z499C or Z555C.
     3.E003C is not payable for anaesthesia services rendered for Z491, Z492, Z493, Z494, Z495,
        Z496, Z497, Z498, Z499 or Z555.
     4.Colonoscopy to investigate chronic constipation is only insured when:
         a.patients are aged 50 years or older;
         b.patients have family history associated with an increased risk of malignancy,
           in accordance with current Ontario generally accepted clinical practice guidelines; or
         c.it is necessary to exclude organic disease for patients with alarm features, such as
           bleeding, abdominal pain and new onset symptoms.
     [Commentary:
     The Choosing Wisely Canada Recommendation to avoid performing colonoscopy for
     constipation in those under the age of 50 years without family history of colon cancer or alarm
     features may be found at the following link: https://choosingwiselycanada.org/gastroenterology/
     .]
# E740   - to splenic flexure, to Z491, Z492, Z493, Z494, Z495, Z496,
           Z497, Z498, Z499 or Z555 ......................................... add          nil          51.75
# E741   - to hepatic flexure, to Z491, Z492, Z493, Z494, Z495, Z496,
           Z497, Z498, Z499 or Z555 ......................................... add          nil          31.15
# E747   - to cecum, to Z491, Z492, Z493, Z494, Z495, Z496, Z497,
           Z498, Z499 or Z555 ................................................... add      nil          31.15
# E705   - into terminal ileum, to Z491, Z492, Z493, Z494, Z495,
           Z496, Z497, Z498, Z499 or Z555............................... add                            30.30
# E630   - endoscopic placement of stent in colon, to Z491, Z492,
           Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 add                                       137.05
# E717   - if biopsy and/or coagulation of angiodysplastic lesion(s)
           (one or more), to Z491, Z492, Z493, Z494, Z495, Z496,
           Z497, Z498, Z499, Z555 or Z580............................... add                            27.05
# E785   - multiple biopsies for surveillance of inflammatory bowel
           disease-associated colorectal cancer or dysplasia, to
           Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499
           or Z555add                                                                                   54.25
# E797   - management of uncomplicated upper or lower
           gastrointestinal bleeding, by any technique (e.g. laser,
           injection, diathermy, banding etc.) to Z496 or Z497... add                                   46.30
 E749    - when Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498,
           Z499, Z512, Z555 or Z580 rendered in private office add                                      22.35
     Note:
     1.E717 rendered in conjunction with E785 is not eligible for payment.
     2.For sigmoidoscopy with rigid scope, see Z535 (Rectum).
     3.E785 is only eligible for payment when:
        a.billed with diagnostic code 555 for Crohn’s disease, 556 for ulcerative colitis, or 576 for
          primary sclerosing cholangitis; and

PDF page 727 / T7

BLADDER
                                                                                                                    Asst   Surg     Anae
      ENDOSCOPY - CYSTOSCOPY
      Diagnostic and Therapeutic Procedures
  # Z606 Diagnostic with or without urethroscopy .................................                 77.00 5
  # Z607 Repeat within 30 days ............................................................        38.05 5
  # E775    - with catheterization of the ureter and collection of the
              ureteral specimen, unilateral...................................... add              16.45
  # E817    - with catheterization of the ureter and retrograde injection
              of opaque media, unilateral........................................ add              16.45
  # E776    - with unilateral brush biopsy of renal pelvis and/or ureter,
              and/or transurethral biopsy of bladder ....................... add                   26.70
  # E818    - with insertion of ureteric stent, unilateral.................... add                 26.70
  # E777    - with cystometrogram (to include urethral pressure profile if
              necessary) ................................................................. add     12.35
  # E783    - with secondary surgical evacuation of bladder clots and
              control of haemorrhage.............................................. add            106.80
  # E784    - with hydrodistention of bladder - general anaesthetic add                            53.45
  # E824    - with bladder biopsy - general anaesthetic.................. add                      53.45
  # E773    - with placement of ureteric stent past obstructing lesion
              (unilateral) .................................................................. add  53.50
        Note:
        1.Only one of E773 or E818 is eligible for payment for the same ureteric obstruction.
        2.Time units and anaesthesia extra units listed on GP97 are not eligible for payment with
          anaesthesia services for Z606C or Z607C.
        3.E003C is not payable for anaesthesia services rendered for Z606 or Z607.
  # E791    - with periurethral injection of bulking agents ............... add                    50.70
        Payment rules:
        1.E791 is not eligible for payment with any procedural fee code other than Z606
        2.E791 is only eligible for payment for one treatment per patient every 16 weeks
  # E781    - with electrocoagulation - tumour(s)............................ add     53.50
  # E782    - with electrocoagulation - Hunner ulcer....................... add       53.50
  # E786                                  - with resection or incision bladder neck, female ......... add                  106.85
  # E787                                  - with resection or incision bladder neck, male ............ add                 279.20
  # E788                                  - with ureteral meatotomy, by any means .................... add                  99.70
  # E789                                  - with removal foreign body or calculus........................ add              106.85
  # E790                                  - with removal of ureteric catheter................................ add            9.45
  # E751    - with insertion of chemotherapeutic agent(s) .............. add                                                58.65
        Note:
        E751 is not eligible for payment with Z603 or Z611.
        Excision of tumour or tumours including base and adjacent muscles and electrocoagulation,
        if necessary
  # Z632 - single tumour 1 to 2 cm diameter .......................................           290.90 6
  # Z633 - single tumour over 2 cm diameter ......................................            468.70 6
  # Z634 - multiple tumours ................................................................. 468.70 6

PDF page 771 / Y5

Payment rules:
                                          1.Time units and anaesthesia extra units listed on GP97 are not eligible for payment with
                                            anaesthesia services for E138C, E139C, E140C, E141C, E144C, E145C or E146C.
                                          2.E003C is not payable for anaesthesia services rendered for E138, E139, E140, E141, E144,
                                            E145 or E146.
                                          3.E145 and E146 are only eligible for payment for revisions to previously implanted artificial
                                            intraocular lens.
                                          4.E950 is only eligible for payment with E144 when dislocated implanted artificial intraocular
                                            lens is removed and replaced during same surgery.
                                          5.E146 is not eligible for payment with E140, E141 or E144.
                                          [Commentary:
                                          1.Refer to E023C on GP100 for anaesthesia services other than procedural sedation rendered
                                            in support of E138, E139, E140, E141, E144, E145 and E146.
                                          2.Local infiltration or topical anaesthesia used as an anaesthetic for any procedure is not
                                            eligible for payment.]

PDF page 772 / Y6

Injections and/or paracentesis
# E186 Intravitreal injection of medication for the treatment of wet
           macular degeneration, left eye ............................................               nil          90.00          5
# E187 Intravitreal injection of medication for the treatment of wet
           macular degeneration, right eye..........................................                 nil          90.00          5
# E149 Vitreous injection or aspiration, posterior with needle for culture
          and/or injection of medication, other than for macular
          degeneration .......................................................................       nil          90.00          5
# E175    - therapeutic paracentesis, to E186, E187, or E149 .....add                                             20.00
# E142 Preretinal membrane peeling or segmentation to include
            vitrectomy, complete and by posterior approach, with or
            without vitreous exchange (air, gas, or artificial vitreous
            substance) .......................................................................... 6 920.00 6
      Payment rules:
      1.E186 and E187 are each limited to 12 per patient per 12-month period. Services in excess of
        this limit are only eligible for payment in exceptional circumstances where warranted by
        clinical conditions. Physicians must document the appropriate clinical indications for services
        in excess of the limit on the patient’s permanent medical record.
         2.Time units and anaesthesia extra units listed on GP97 are not eligible for payment with
           anaesthesia services for E186C, E187C, or E149C.
         3.E003C is not payable for anaesthesia services rendered for E186, E187, or E149.
         4.If paracentesis is performed through the same site as E186, E187, or E149, E175 is not
           eligible for payment.
         5.E148, E142, E149, E186, E187, E175, Z851 are not eligible for payment with E112
         6.E940 is not eligible for payment with E142 or E148.
         7.E154 is not eligible for payment with E142 except when extensive pan-retinal laser
           coagulation is required to treat underlying pathology resulting in two separate procedures
           being performed and each are documented in the medical record.
         8.E151 is only eligible for payment with E142 or E148 when laser is performed to treat a retinal
           detachment with presence of subretinal fluid, in association with the vitrectomy.
         9.E141 is only eligible for payment with E142 or E148 when removal of the lens fragments in
           the posterior vitreous substance requires the use of a separate instrument (fragmatome unit).
         10.E148 and E142 include the removal of silicone oil along with residual vitreous, if performed.

Master, record 870. Record Layout PDF, page 1.

E00320260401999999990000000000000000774600000000000000000063840000000638400

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.