Z156 – Removal of single lesion by excision and suture
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This service involves the surgical removal of a single Group 1 skin lesion, such as keratosis or pyogenic granuloma, followed by suture closure. This service is only insured when there is clinical suspicion of disease or malignancy; removal for purely cosmetic reasons is not covered. Refer to Appendix D of the Schedule of Benefits for surface pathology classifications. An additional fee, E542, can be claimed when this procedure is performed in a non-hospital setting.
When to Use
- Use Z156 for the excision and suture of a single Group 1 lesion, such as a symptomatic keratosis or pyogenic granuloma, where malignancy is suspected.
- Use Z156 when a lesion requires surgical excision and closure, as opposed to simple curettage or cauterization which may fall under different procedural codes.
Common Pitfalls
- Claiming Z156 for cosmetic removals (e.g., skin tags or benign nevi without clinical suspicion) will lead to recovery during an audit as these are not insured services.
- Failing to document the specific clinical suspicion or the necessity for excision in the patient chart is a common cause for claim rejection or clawback.
- Billing Z156 for multiple lesions on the same day without appropriate modifier usage or documentation of separate sites can result in payment denials.
Billing Tips
- Always append E542 to your claim when performing Z156 in your office to capture the non-hospital setting premium.
- Ensure the pathology report or clinical notes clearly support the 'suspicion of disease' to satisfy the documentation requirements for this surgical code.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
The medical record must document clinical suspicion of disease or malignancy to justify the procedure as medically necessary.
Tattoo removal - (see Appendix D Surface Pathology Section 3).
Removal of any lesions (e.g. keratosis, nevi) for cosmetic purposes and not for any clinical suspicion of disease or malignancy is not an insured service.
Group 1 - e.g. keratosis, pyogenic granuloma (see Appendix D Surface Pathology)
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