E687

PDF page 701 / S19

DIGESTIVE SYSTEM SURGICAL PROCEDURES
 INTESTINES (EXCEPT RECTUM)
                                                                              Asst     Surg     Anae
              b.multiple random screening biopsies (>34 sites) for malignant changes in inflammatory
                bowel disease, or targeted biopsies have been collected using 1) Dye-chromoendoscopy
                (DCE), 2) virtual chromoendoscopy (VCE) with narrow band imaging (NBI), or 3) high-
                definition white-light-endoscopy (HD-WLE) with HD-iScan, or equivalent.
         [Commentary:
         1.E749 is not eligible for payment in a hospital or ICHSC.
         2.For assessments claimed same day as colonoscopy by Internal Medicine (13) or
           Gastroenterology (41) see A120.
         3.E785 is not eligible for payment in the context of standard definition white light endoscopy
           (SD-WLE).]
# Z513 Hydrostatic - Pneumatic dilatation of colon stricture(s) through
         colonoscope .......................................................................              107.50
# Z571 Excision of first polyp (3 mm to 5mm).....................................                   nil   150.15   4
# E720   - each additional polyp (3 mm to 5 mm)....................... add                                 77.50
# Z518 Excision of first polyp (6 mm to 9 mm)....................................                   nil   150.15   4
# E520   - each additional polyp (6 mm to 9 mm)...................... add                                  77.50
# Z517 Excision of first polyp (10 mm to 19 mm)................................                     nil   150.15   4
# E519   - each additional polyp (10 mm to 19 mm ................... add                                   77.50
# Z516 Excision of first polyp (20 mm to 29 mm)................................ nil 150.15                         4
# E518    - each additional polyp (20 mm to 29 mm).................. add             77.50
      Payment rules:
      1.Only one of Z571, Z518, Z517 or Z516 is eligible for payment per patient per day.
         2.A maximum of 2 services of any combination of E720, E520, E519, or E518 are eligible for
            payment per patient per day.
         3.Excision of polyps <3mm is not eligible for payment.
         Claims submission instructions:
         The largest polyp excised should be used to determine the appropriate fee code to claim for the
         first polyp (Z571, Z518, Z517 or Z516).
      Note:
      Z497, Z499, Z492, Z493, Z496, Z494, Z498, Z495, Z491, and Z555 include fulguration, if
      performed.
# E685 Total excision of very large sessile polyp (> 3 cm) through
           colonoscope, and may include fulguration, each ...............      227.65
      Excision of obstructive tumour or stricture through colonoscopy
# Z764 - less than 2 cm. ...................................................................               69.80
# Z765 - 2 cm or greater ...................................................................              131.75
# E687    - with laser debulking ................................................... add                   69.80

Master, record 1383. Record Layout PDF, page 1.

E68720250401999999990000069800000000000000000000000000000000000000000000000

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.