Z498

PDF page 114 / GP100

Ocular Surgery, Cystoscopy, and Examination Under Anaesthesia
               E023C Anaesthesia service for E138, E139, E140, E141, E144, E145,
                        E146, E186, E187, E149, Z432, Z606, or Z607
                         ............................................. 6 basic units, plus time units.
      Colonoscopy and Sigmoidoscopy
   E032C Anaesthesia service for Z491, Z492, Z493, Z494, Z495, Z496,
                Z497, Z498, Z499, Z555 or Z580
                .............................................. 4 basic units, plus time units
        [Commentary:
        1.Deep sedation, general anaesthesia or regional anaesthesia, performed by an
          anaesthesiologist, are examples of anaesthesia that may be rendered for E023C and E032C.
        2.Anaesthesia extra units listed on GP97 are eligible for payment with E023C and E032C.
        3.Local infiltration or topical anaesthesia used as an anaesthetic for any procedure is not
          eligible for payment.]
        Note:
        For the purposes of anaesthesia services the following definitions apply:
        1.Procedural Sedation is a drug-induced depression of consciousness during which patients
          respond purposefully to verbal commands, either alone or accompanied by light tactile
          stimulation. No interventions are required to maintain a patent airway, and spontaneous
          ventilation is adequate. Cardiovascular function is usually maintained.
        2.Deep Sedation is a drug-induced depression of consciousness during which patients cannot
          be easily aroused but respond purposefully following repeated or painful stimulation. The
          ability to independently maintain ventilatory function may be impaired. Patients may require
          assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate.
          Cardiovascular function is usually maintained.
        3.General Anaesthesia is a drug-induced loss of consciousness during which patients are not
          arousable, even by painful stimulation. The ability to independently maintain ventilatory
          function is often impaired. Patients often require assistance in maintaining a patent airway,
          and positive pressure ventilation may be required because of depressed spontaneous
          ventilation or drug-induced depression of neuromuscular function. Cardiovascular function
          may be impaired.
  ANAESTHESIA ADMINISTERED BY SAME PHYSICIAN PERFORMING A PROCEDURE
    1. Except as described in paragraph 2, when a physician administers an anaesthetic, nerve block
       and/or other medication prior to, during, immediately after or otherwise in conjunction with a
       diagnostic, therapeutic or surgical procedure which the physician performs on the same patient,
       the administration of the anaesthetic, nerve block and/or other medication is not eligible for
       payment.

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 699 / S17

DIGESTIVE SYSTEM SURGICAL PROCEDURES
 INTESTINES (EXCEPT RECTUM)
                                                                                  Asst       Surg       Anae
    Colonoscopy - For diagnosis or ongoing management
# Z496 Presence of signs or symptoms - sigmoid to descending colon                                  nil 51.95 5
# Z494 Hereditary (e.g. Familial adenomatous Polyposis or Hereditary
           Non-Polyposis Colorectal Cancer) or other bowel disorders
           (e.g. inflammatory bowel disease) associated with
           increased risk of malignancy ..............................................              nil 51.95 5
      Payment rules:
      Z494 is eligible for payment when rendered at the age and frequency of follow up in
      accordance with generally accepted clinical practice guidelines.
# Z498 Follow up of abnormal colonoscopy - sigmoid to descending
           colon................................................................................... nil 51.95 5
      Payment rules:
      1.Z498 is eligible for payment for a colonoscopy rendered for the follow-up of a patient with a
        previous malignancy(ies) in accordance with current Ontario generally accepted post-
        polypectomy surveillance clinical practice guidelines.
         2.Z498 is eligible for payment when rendered for follow up of polyps in accordance with current
           Ontario generally accepted post-polypectomy surveillance clinical practice guidelines.
         [Commentary:
         Current Ontario colorectal cancer screening and post-polypectomy surveillance guidelines may
         be found at the following links: https://www.cancercareontario.ca/en/guidelines-advice/cancer-
         continuum/screening/resources-healthcare-providers/colorectal-cancer-screening-summary
         and https://www.cancercareontario.ca/en/guidelines-advice/cancer-continuum/screening/
         resources-healthcare-providers/post-polypectomy-surveillance-recommendations-summary]
# Z495 Follow up of unsatisfactory colonoscopy ................................ nil    51.95     5
      Payment rules:
      Z495 is only eligible for payment for a technically unsatisfactory colonoscopy due to poor
      preparation, failure to intubate the cecum or inability to complete the examination
# Z491 Follow up of incomplete polyp resection................................. nil    51.95     5
      Payment rules:
      1.Z491 is only eligible for payment for:
         a.Sessile polyps that were only partially removed; or
         b.Adenomatous polyps that were removed piecemeal or contained high grade dysplasia.
      2.Z491 is not eligible for payment if performed more than six months following the initial
        colonoscopy.
# Z555 Absence of signs or symptoms or risk factors, 50 years of age
           or older - sigmoid to descending colon............................... nil 51.95       5
      Payment rules:
      Z555 is an uninsured service for the same patient in the 10 year period following the previous
      Z555.
         Note:
         1.Only one of Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 is eligible for
           payment per patient per day.

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 7230. Record Layout PDF, page 1.

Z49820260401999999990000051950000000000000000000000000000079800000000798000

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.