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Billing code

Z496A — Colonoscopy - For Diagnosis Or Ongoing Management - Presence Of Signs Or Symptoms Sigmoid To Descending Colon

Diagnostic colonoscopy

Bill for colonoscopy to diagnose or manage a patient with signs or symptoms; going past the descending colon uses extent add-ons.

Watch for: Only one colonoscopy code per patient per day, and flexible sigmoidoscopy Z580 isn't payable with it the same day.

Code

Z496A

Description

Colonoscopy - For Diagnosis Or Ongoing Management - Presence Of Signs Or Symptoms Sigmoid To Descending Colon

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Colonoscopy for diagnosis or ongoing management when signs or symptoms are present. Only one colonoscopy code per patient per day.

What it covers

Z496 is a colonoscopy, sigmoid to descending colon, for diagnosis or ongoing management in a patient with signs or symptoms (S17). Each colonoscopy code has the same extent and differs by indication: screening (Z555), positive screening test (Z497), family history (Z499), hereditary or IBD risk (Z494), and the follow-up codes Z491, Z492, Z493, Z495 and Z498 (S16–S17).

Going further is billed with the extent add-ons E740 (splenic flexure), E741 (hepatic flexure), E747 (cecum) and E705 (terminal ileum) (S18). Z496 includes fulguration if done, and no surgical assistant fee is payable (S17, S19).

Billing rules

• Only one of Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 per patient per day (S17).
• Z580 flexible sigmoidoscopy isn't payable with Z496 for the same patient the same day (S15).
• Colonoscopy to investigate chronic constipation is insured only for patients 50 or older, patients with a family history of increased cancer risk under Ontario guidelines, or to exclude organic disease when there are alarm features such as bleeding, abdominal pain or new onset symptoms (S18).
• As a Z code it is an IOP: if you did the major pre-operative visit in the previous 12 months, only a minor assessment (GP/FP) or a partial assessment (specialist) is payable before the procedure that day (SP4).
• Internal Medicine (13) and Gastroenterology (41): A120 is the only assessment payable the same day if any physician did a major pre-operative visit in the previous 12 months, and isn't payable when a major pre-operative visit is payable that day (A104, S19).
• Anaesthesia by an anaesthesiologist (deep sedation, general or regional) is billed as E032C, which replaces the listed anaesthesia units; E003C isn't payable (GP100, S18).
• Marked '#': the fee doesn't include premises, equipment, supplies or staff, which are funded by the hospital budget or ICHSC facility costs; patients can't be charged for them (GP13).

Often billed with

• E740, E741, E747 and E705 for the extent reached (S18).
• A034 General Surgery partial assessment before the procedure, within the IOP rules (SP4, A107).
• Polypectomy Z571, Z518, Z517 or Z516 for the largest polyp, with up to 2 of E720, E520, E519 or E518 (S19).
• E717 biopsy or coagulation of angiodysplastic lesions, or E785 IBD surveillance biopsies, but not both (S18).
• E797 for management of uncomplicated GI bleeding, listed only to Z496 or Z497, and E749 in a private office (S18).

Related codes: Z555, Z497, Z498, Z494, Z499, Z580, E740, E747

Source: Schedule of Benefits (July 1, 2026), Digestive System Surgical Procedures, Intestines (Except Rectum), Colonoscopy - For diagnosis or ongoing management, page S17 (add-ons S18, polyps S19, Z580 S15); General Preamble GP100; Surgical Preamble SP4

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