Z535

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 707 / S25

DIGESTIVE SYSTEM SURGICAL PROCEDURES
      RECTUM
                                                                                                    Asst    Surg     Anae
      ENDOSCOPY
      Sigmoidoscopy with or without anoscopy
    Z535 - with rigid scope...................................................................               36.80    4
    Z536 - with biopsy(ies)...................................................................               44.55    4
    Z592 - with decompression of volvulus..........................................                          49.40    4
    E746   - when Z535, Z536 or Z592 performed outside hospitaladd                                            5.85
  # E641   - endoscopic placement of stent in rectum................... add                                 137.05
  # E797   - management of uncomplicated upper or lower
             gastrointestinal bleeding, by any technique (e.g. laser,
             injection, diathermy, banding etc.) ............................. add                           46.30
                                          Note:
                                          Z535 not to be billed with Z555 or Z580.

Master, record 7263. Record Layout PDF, page 1.

Z53520260401999999990000036800000000000000000000000000000063840000000638400

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.