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 (03); Anaesthesia (01); Family Medicine (00); Emergency Medicine (12); Critical Care Medicine (11); Cardiac Surgery (09); Respiratory Disease (47); General Thoracic Surgery (64); Vascular Surgery (17); Paediatrics (26); Internal and Occupational Medicine (13) 
Date of publication: May 27, 2025

Claims Tips: A fee code has been introduced for the removal of a thoracostomy tube on a service day other than the day of insertion.

Z363 – Removal of thoracostomy tube (chest tube)

  • A new fee code for the removal of a thoracostomy tube (chest tube) was added to the Schedule of Benefits – Physician Services (Schedule) effective April 1, 2023.
  • The new fee code is eligible for payment for the removal of a thoracostomy tube with wound closure.
  • Z363 is not eligible for payment:
    • On the same day as fee code Z341, tube thoracostomy (chest tube insertion),
    • On the same day as a surgical procedure that includes the placement of one or more chest tube(s), or
    • For removal of drains other than thoracostomy tubes.

Examples

Example 1: Removal of a single thoracostomy tube

Dr. Santos, a critical care physician working in an intensive care unit (ICU), removes a thoracostomy tube from a patient that was admitted to the ICU two days prior for multiple traumatic injuries.

What fee codes are eligible for payment to Dr. Santos?

Explanation:

  • Z363 is eligible for payment for the removal of the thoracostomy tube and closure of the wound in addition to any Critical Care per diem fees payable for the patient’s care.

Example 2: Removal of multiple thoracostomy tubes post-surgery

Dr. Beckwith removes three thoracostomy tubes inserted at the time of a patient’s open cardiac surgical procedure performed 48 hours prior.

What fee codes are eligible for payment to Dr. Beckwith?

Explanation:

  • If Z363 is claimed three (or more) times for the same patient on the same day, the claims should be submitted with the manual review indicator, accompanied by supporting documentation from the patient’s medical record, to demonstrate why three (or more) thoracostomy removals were required for that patient on that day.
  • In this example, Dr. Beckwith provided a copy of the operating room note documenting the insertion of three chest tubes as well as the chart note from the date of removal documenting the removal of all three chest tubes, which demonstrated the need for each thoracostomy removal. As such, Z363 x 3 is eligible for payment to Dr. Beckwith.

Example 3: Removal of thoracostomy tube and drain post-surgery

Dr. Carlton, a thoracic surgeon, removes a patient’s thoracostomy tube and axillary drain, which were both inserted as part of a partial pneumonectomy performed by Dr. Carlton 2 days prior.

What fee codes are eligible for payment to Dr. Carlton?

Explanation:

  • Z363 is eligible for payment for the removal of the thoracostomy tube and closure of the wound, as removal did not occur on the same day that it was inserted.
  • Removal of a simple drain (such as the axillary drain) is considered part of post-operative care and is included in the payment for the preceding surgical procedure in which the drain was installed. Therefore, removal of the axillary drain is not eligible for payment as Z363.

Example 4: Removal and replacement of a thoracostomy tube

Dr. Martell is an emergency physician working at a large urban hospital who assesses a patient transferred from another institution following a motor vehicle collision. The patient had a thoracostomy tube inserted as part of the initial stabilization prior to transfer. Dr. Martell observes that the original thoracostomy tube is no longer draining and decides to remove it and insert a larger tube in a different location.

What fee codes are eligible for payment to Dr. Martell?

Explanation:

  • Z341 is eligible for payment for the newly inserted thoracostomy tube.
  • As per the payment rule on page P13 of the Schedule, Z363 is not eligible for payment for removal of a chest tube for the same patient on the same day as Z341.

Keywords/tags

OHIP Claims; OHIP Payment; Thoracostomy Tube; Chest Tube, Chest Drainage; Z363; Z341

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 Inquiry Services, Service Support Contact Centre (SSCC) by email or by calling 1-800-262-6524.

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 MOH/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 1-800-262-6524.

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 1-800-262-6524.