Education and Prevention Committee Billing Briefs
Education and Prevention Committee (EPC) Billing Briefs are prepared jointly by the Ministry of Health (MOH) and the Ontario Medical Association (OMA) to provide general advice and guidance to physicians on billing matters.
Category: General Surgery, Gastroenterology, Anaesthesia, GP-Anaesthesia
Date Issued: June27,2024
Background
As of April1,2023, the Schedule of Benefits – Physician Services (Schedule) includes changes to fee codes for excision of polyps during colonoscopy. This change introduces new fee codes that reflect the size of polyps that are removed.
Note that fee codes for polyp fulguration have been removed from the Schedule, reflecting current best practices.
Excision of polyps
Claims tip: The largest excised polyp that is 3 to 29mm should be used to determine the appropriate fee code to claim as one of Z571, Z518, Z517 or Z516). Note that the largest polyp does not need to be removed first.
Polyps less than 3mm
Consistent with the previous version of the Physician Schedule of Benefits, excision of polyps less than 3mm are not eligible for payment.
Removal of largest polyp – 3 to 29mm
Four new fee codes have been introduced for the resection of the largest polyp during colonoscopy. Although these are named “first polyp” the order of excision is not relevant to claims submission.
Only one of these fee codes is eligible for payment per patient per day.
- Z571 – excision of first polyp – polyp size from 3 to 5mm
- Z518 – excision of first polyp – polyp size from 6 to 9mm
- Z517 – excision of first polyp – polyp size from 10 to 19mm
- Z516 – excision of first polyp – polyp size from 20 to 29mm
Note that if more than one of these fee codes is submitted for the same patient on the same day, the additional fee code(s) will pay at zero.
Removal of additional polyp(s) – 3 to 29mm
Four new fee codes have been introduced for the resection of additional polyps (if applicable) during colonoscopy.
A maximum of two services of any combination of these fee codes, E720, E520, E519, or E518, are eligible for payment per patient per day.
- E720 – excision of additional polyp – polyp size from 3 to 5mm
- E520 – excision of additional polyp – polyp size from 6 to 9mm
- E519 – excision of additional polyp – polyp size from 10 to 19mm
- E518 – excision of additional polyp – polyp size from 20 to 29mm
Note that if more than two of these fee codes are submitted for the same patient on the same day, the additional fee code(s) will pay at zero.
Removal of sessile polyps greater than 30mm (3cm)
Large sessile polyps (over 30mm) excised through the colonoscope will continue to be payable using fee code E685.
Excision of these polyps does not contribute to the maximum of three excisions of polyps less than 30mm eligible for payment per patient per day.
Fulguration of polyps
Fee codes for fulguration of polyps (Z570 and E719) have been removed from the Schedule to reflect current practice.
Fee codes Z497, Z499, Z492, Z493, Z496, Z494, Z498, Z495, Z491, Z555, and E685 include fulguration, if performed.
Examples
Example1 – excision of more than 3polyps (all larger than 3mm)
Dr. Cousineau performs a routine follow-up colonoscopy of a 72-year-old patient and removes one 15mm polyp, one 8mm polyp and three polyps ranging between 3mm and 5mm.
What fee codes are eligible for payment to Dr. Cousineau for the excision of these polyps in addition to the appropriate colonoscopy fee code(s)?
Explanation
- The largest polyp excised was 15mm therefore fee code Z517 is eligible for payment.
- Excision of the 8mm polyp is eligible for payment using fee code E520.
- Excision of one of the polyps between 3 and 5mm is eligible for payment using fee code E720.
- A maximum of three polyps from 3 to 29mm are eligible for payment.
- The additional excised polyps are not eligible for payment.
Example2 – fulguration of polyps
Dr. Ahmad performs a colonoscopy on a 55-year-old patient, because of a positive fecal occult blood test. In the descending colon Dr. Ahmad excised three 5mm polyps and fulgurated two smaller polyps.
What fee codes are eligible for payment to Dr. Ahmad for treatment of these polyps in addition to the appropriate colonoscopy fee code(s)?
Explanation
- The largest polyp excised was 5mm, therefore fee code Z571 is eligible for payment.
- Excision of the second and third 5mm polyps are eligible for payment using fee code E720 which may be claimed twice.
- Fulguration of the additional polyps are included in the base fee for the colonoscopy and are not eligible for payment as polyp excision fee codes.
Example3 – excision of a sessile polyp larger than 30mm
Dr. Brennan performs a colonoscopy to investigate intermittent episodes of bleeding. During the procedure Dr. Brennan excises a 35mm sessile polyp in the patient’s colon and removes three additional polyps (12mm, 8mm and 4mm).
What fee codes are eligible for payment to Dr. Brennan for treatment of these polyps in addition to the appropriate colonoscopy fee code(s)?
Explanation
- Fee code E685 is eligible for payment for the removal of the 35mm sessile polyp.
- Excision of the 12mm polyp is eligible for payment using fee code Z517.
- Excision of the 8mm and 4mm polyps are eligible for payment using fee codes E520 and E720 respectively.
Example4 – excision of polyps less than 3mm
Dr. Brennan performs a repeat colonoscopy on the same patient one year later. Dr. Brennan identifies no polyps 3mm or greater but does remove three 2mm polyps.
What fee codes are eligible for payment to Dr. Brennan for treatment of these polyps in addition to the appropriate colonoscopy fee code(s)?
Explanation
- Excision of polyps less than 3mm are included in the base fee for the colonoscopy and are not eligible for payment as polyp excision fee codes.
Keywords/Tags
OHIP Claims; OHIP Payment; Colonoscopy; Polyps; Fulguration; Excision; General Surgery; Gastroenterology; Anaesthesia
More information
InfoBulletin 231203
Claims contact information
For additional information, please visit the Resources for Physicians and the How to Get Help with Billing Questions pages on the ministry website.
If you have any billing or claims submission inquiries, please contact the Service Support Contact Centre (SSCC) by email or by calling
To provide feedback on EPC Billing Briefs, or to suggest topics for future EPC Billing Briefs, send an email to the attention of the joint Ministry of Health/OMA Education and Prevention Committee.
The Ministry of Health (MOH) and the Ontario Medical Association (OMA) have jointly prepared this educational resource to provide general advice and guidance to physicians on specific billing matters.
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Note: This document is technical in nature and is available in English only due to its limited targeted audience. This publication has been exempted from translation under the French Language Services Act. For questions or support regarding this document, please contact the Service Support Contact Centre (SSCC) by email or by calling
Remarque: Ce document est de nature technique et est disponible en anglais uniquement en raison de son public cible limité. Ce document a été exempté de la traduction en vertu de la Loi sur les services en français. Pour toute question ou de l’aide concernant ce document, veuillez contacter Les Services de renseignements, Centre de contact pour le soutien des services par courriel ou en téléphonant le
