Z113 – Biopsy - any method, when sutures are not used
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Biopsy - any method, when sutures are not used. As a 'Z' prefix surgical procedure, it is subject to general rules for surgical services outlined in the Schedule of Benefits. This includes the inclusion of common and specific elements of insured services (, , ), rules for admission assessments (, ), and eligibility for various premiums such as age-based (), after-hours (), and trauma ().
When to Use
- Use Z113 for a punch or shave biopsy of a skin lesion where the wound is left to heal by secondary intention or closed with adhesive strips rather than sutures.
- Select Z113 when performing an incisional biopsy of a mucosal or cutaneous lesion that does not require formal surgical closure.
Common Pitfalls
- Billing Z113 in addition to an excision code (e.g., Z110-Z112) for the same lesion is considered unbundling and will result in a rejection.
- Submitting Z113 when sutures are actually used for closure is a billing error; you must use the appropriate excision or minor surgery code that accounts for the closure method.
Billing Tips
- Z113 is a 'Z' prefix surgical procedure, meaning you can claim age-based premiums (GP64) or after-hours premiums (GP104) if the service criteria are met.
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 that establish 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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