Z104 – Abscess or haematoma - Local anaesthetic - perianal
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This code is for a surgical procedure within the Z-prefix category. According to the general preamble, suffix 'A' is required for the operating surgeon. Assistant and anaesthesia services are not eligible for payment with this code, as indicated by the fee schedule data. General rules for surgical procedures, including restrictions on billing admission assessments and eligibility for age-based, after-hours, and trauma premiums, apply.
When to Use
- Use Z104 for the incision and drainage of a perianal abscess or evacuation of a perianal haematoma when performed within a hospital setting.
- Select Z104 when the procedure is performed under local anaesthetic, as it is specifically designated for minor perianal surgical interventions.
Common Pitfalls
- Billing Z104 in conjunction with an admission assessment code is a common audit trigger, as the assessment is considered included unless it qualifies as the major pre-operative visit.
- Attempting to bill for an assistant or anaesthetist will result in automatic rejection, as these services are strictly ineligible for this procedure code.
Billing Tips
- If the procedure is performed in an office or clinic setting outside of a hospital, ensure you add the E542 premium to receive the appropriate compensation for the location.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Musculoskeletal System Surgical Procedures
All insured services must be documented in appropriate records establishing that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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