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Billing code

Z498A — Follow Up Of Abnormal Colonoscopy Sigmoid To Descending Colon

Surveillance colonoscopy

Bill for follow-up colonoscopy after a previous malignancy or polyps, at intervals in Ontario post-polypectomy surveillance guidelines.

Watch for: Incompletely removed polyps are Z491 and unsatisfactory repeats are Z495; only one colonoscopy code per patient per day.

Code

Z498A

Description

Follow Up Of Abnormal Colonoscopy 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 to follow up a previous malignancy or polyps, at intervals set by Ontario post-polypectomy surveillance guidelines.

What it covers

Z498 is the colonoscopy for follow-up of an abnormal colonoscopy, in the diagnosis and ongoing management group. The fee covers the scope from the sigmoid to the descending colon; further extent is billed with add-ons (S17, S18).

It is payable for follow-up of a patient with a previous malignancy, or for follow-up of polyps, in accordance with current Ontario post-polypectomy surveillance guidelines (S17).

Billing rules

• Payable only for follow-up of previous malignancy or polyps at the intervals in current Ontario post-polypectomy surveillance guidelines (S17).
• Follow-up of an incompletely resected polyp (sessile polyp only partly removed, or adenomatous polyp removed piecemeal or containing high grade dysplasia) has its own code, Z491, which isn't payable more than six months after the initial colonoscopy (S17).
• A repeat after a technically unsatisfactory colonoscopy (poor preparation, cecum not intubated, examination not completed) is Z495 (S17).
• Only one of Z491, Z492, Z493, Z494, Z495, Z496, Z497, Z498, Z499 or Z555 is payable per patient per day (S17). Z580 flexible sigmoidoscopy isn't payable with it the same day (S15).
• Fulguration, if performed, is included (S19). No surgical assistant fee is payable (Asst nil) (S17).
• E797 bleeding management is listed at colonoscopy only for Z496 and Z497, not Z498 (S18).
• Anaesthesia other than local infiltration, topical anaesthesia or procedural sedation is claimed as E032C (4 basic units plus time units), which replaces the listed basic and time units; GP97 extra units are payable with E032C (GP100). Time units and GP97 extra units aren't payable with Z498C, and E003C isn't payable for anaesthesia for Z498 (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 (splenic flexure), E741 (hepatic flexure), E747 (cecum) and E705 (terminal ileum) for how far the scope was passed (S18).
• Z571, Z518, Z517 or Z516 for the largest polyp removed, with E720, E520, E519 or E518 for up to 2 more (S19).
• A035 consultation (when it is the visit where the decision to scope is made) or A034 partial assessment (when the major pre-operative visit was in the previous 12 months) for a general surgeon (SP4, A107).
• Internal Medicine (13) and Gastroenterology (41): A120 is the only assessment payable on the colonoscopy day when any physician did the major pre-operative visit in the previous 12 months, and isn't payable when a major pre-operative visit is payable that day (A104).

Related codes: Z491, Z495, Z493, Z496, Z518, E520, E740, E747

Source: Schedule of Benefits (July 1, 2026), Digestive System Surgical Procedures, Intestines (Except Rectum), Colonoscopy - For diagnosis or ongoing management, page S17; notes S18-S19; anaesthesia GP100.

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