E785

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 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 1480. Record Layout PDF, page 1.

E78520250401999999990000054250000000000000000000000000000000000000000000000

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.