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Ontario Health Insurance Plan

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INFOBulletin

Keeping Health Care Providers informed of payment, policy or program changes

To: All Providers

Published by: Claims Services Branch, Ministry of Health

Date Issued: December 13, 2019

Bulletin Number: 11220

Re: Kaplan Board of Arbitration Award - Appropriateness Working Group (AWG): Laryngoscopy in association with Gastroscopy Changes to the Schedule of Benefits (Schedule) Effective October 1, 2019

Posted Electronically Only

PDF Version


Kaplan Board of Arbitration Award - Appropriateness Working Group (AWG)

As directed by the February 2019 Kaplan Board of Arbitration Award, the Ministry of Health and the Ontario Medical Association (OMA) formed the Appropriateness Working Group (AWG) with a mandate to use evidence, best practices and expert opinion to identify and update the delivery of certain services to help ensure the most effective care for Ontario patients.

Effective for service dates on or after October 1, 2019, two new fee schedule codes have been created to replace the Z321 Laryngoscopy with/without biopsy fee code that was delisted September 30, 2019. The two new codes are:

Z292 - Laryngoscopy without biopsy
Z293 - Laryngoscopy with biopsy

Only a Z292 or a Z293 will pay for the same patient, same physician, same service date; the second fee code will pay at $0.00 with explanatory code ‘D7 - Not allowed in addition to other procedure’.

Z292 is eligible for payment on its own or with non-upper Gastrointestinal (GI) scopes.

Z292 rendered in association with gastroscopy, oesophagoscopy, oesophagoscopy-gastroscopy, duodenoscopy, and small bowel push enteroscopy is not eligible for payment unless the laryngoscopy service is rendered for suspicion of disease of the larynx. In this circumstance the claim should be flagged for manual review and will require a written explanation.

Associated premiums including Age premium, Paediatric Age premium and Anaesthetic Age premium may be applied to both the Z292 and Z293.

Claims submitted with service dates on or after October 1, 2019 and that were paid between October 1, 2019 and December 3, 2019, will be adjusted accordingly to relfect payment rules in the Schedule. You will be notified through an INFOBulletin once the adjustment processing begins.

For details related to the AWG changes to the Schedule effective October 1, 2019, please refer to INFOBulletin # 4726 - Kaplan Board of Arbitration Award - Appropriateness Working Group (AWG): Changes to the Schedule are effective October 1, 2019.

For any further inquiries, please contact the Service Support Contact Centre at:
1-800-262-6524 or SSContactCentre.MOH@ontario.ca

 


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