All codes
L316
L316 – L316
OHIP Dermatology Code · Schedule of Benefits
When to Use
- Use L316 for the excision of a benign skin lesion, such as a sebaceous cyst or lipoma, that requires a simple elliptical excision and primary closure.
- Select L316 when the lesion is located on the trunk or extremities and does not require complex reconstruction or tissue rearrangement.
- Choose L316 over minor procedure codes like G384 when the clinical documentation confirms the removal of a distinct subcutaneous or cutaneous lesion rather than a simple biopsy.
Common Pitfalls
- Billing L316 in addition to a minor assessment code (A007) is generally disallowed unless the assessment is for a separate, unrelated clinical issue.
- Submitting L316 for a lesion that is purely superficial or easily removed via curettage may lead to audit scrutiny; use G384 for superficial biopsies instead.
- Failing to include the specific anatomical site in the claim submission often results in automated rejections or requests for manual review.
Billing Tips
- If you perform multiple excisions during the same encounter, bill the primary lesion as L316 and use the appropriate multiple procedure discount rules for subsequent lesions.
- Ensure the pathology report supports the excision of a lesion; if the pathology returns as 'normal tissue' or 'no lesion identified,' the claim is highly susceptible to recovery during an audit.
Provider Fee$25.85
Effective: April 1, 2018
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