Z157 – Removal of two lesions by excision and suture
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Surgical excision and suture of two Group 1 lesions (e.g., keratosis, pyogenic granuloma). Biopsy, if performed, is included in the service. As noted in the Schedule on page , removal of lesions for cosmetic purposes and not for any clinical suspicion of disease or malignancy is not an insured service. Refer to Appendix D Surface Pathology for detailed classification of Group 1 lesions.
When to Use
- Use Z157 when performing a surgical excision and suture on exactly two Group 1 lesions that require removal due to clinical suspicion of malignancy or disease.
- Use this code when the clinical documentation supports a medical necessity for the excision, distinguishing it from cosmetic removal which is strictly uninsured.
Common Pitfalls
- Billing Z157 for cosmetic removal of lesions, such as benign skin tags or nevi without documented clinical suspicion, will lead to claim rejection or audit recovery.
- Attempting to bill Z157 for more than two lesions; if three or more lesions are removed, you must use the appropriate higher-volume codes or consult the Schedule for correct grouping.
- Failing to document the specific clinical suspicion for each lesion, which is required to justify the fee and avoid it being classified as a non-insured cosmetic procedure.
Billing Tips
- If performing the procedure in an office setting, remember to append the E542 premium to the Z157 claim to receive the additional flat fee.
- Ensure the pathology report or clinical notes explicitly state the reason for excision, as this is the primary evidence required to defend the claim against 'cosmetic' classification.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
Medical record must document the clinical suspicion of disease or malignancy to justify medical necessity, as removal for purely cosmetic purposes is uninsured.
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.
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