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Z097
Z097 – Lipoma - over 10 cm
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Lipoma - over 10 cm
When to Use
- Use Z097 specifically for the excision of a lipoma where the lesion diameter exceeds 10 cm, as this is a distinct surgical code for large-volume soft tissue removal.
- Choose Z097 over general excision codes (e.g., S061) when the size documentation clearly confirms the lesion is greater than 10 cm to ensure appropriate compensation for the increased surgical time and complexity.
Common Pitfalls
- Claiming Z097 for multiple lipomas of smaller sizes; the code is specific to the size of the individual lesion, not the aggregate volume of multiple smaller lipomas.
- Failing to document the measured size in the operative report, which is the primary audit trigger for this specific code to justify the higher fee compared to standard excision codes.
- Attempting to bill a separate hospital admission assessment when the patient was admitted by the surgeon for this procedure, as this is explicitly excluded by the Z-prefix billing rules.
Billing Tips
- Ensure the operative report explicitly states the lesion size in centimeters, as this is the mandatory clinical evidence required to support the use of the Z097 fee over smaller excision codes.
- Bill post-operative visits separately as subsequent visits, as Z-prefix surgical fees do not include the global post-operative period typically found in other surgical fee schedules.
Provider Fee$175.30
Surgical Assistant Fee$77.46
Anaesthetist Fee$95.76
Non-Anaesthetist Fee$95.76
Effective: April 1, 2026
Category
M. Integumentary System Surgical Procedures
Subcategory
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Service Type
Surgical
Code Classes
Integumentary System Surgical Procedures
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