Z162 – Nevus - single lesion
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
This procedure involves the removal of a single nevus lesion by excision and suturing. As per , this service is only insured when there is a clinical suspicion of disease or malignancy and is not payable if performed for cosmetic reasons. This service is categorized under 'Group 2 - nevus' (see Appendix D Surface Pathology, Section 4). The add-on code E542 is applicable when this procedure is performed outside of a hospital setting.
When to Use
- Use Z162 for the excision and suturing of a single nevus when there is a documented clinical suspicion of malignancy, such as change in size, shape, color, or bleeding.
- Use Z162 when performing a biopsy or excision of a symptomatic nevus that is causing physical irritation or pain due to its location, provided the clinical rationale is clearly documented.
Common Pitfalls
- Billing Z162 for the removal of a nevus for purely aesthetic reasons or patient request without clinical suspicion of disease will lead to audit recovery.
- Attempting to bill Z162 alongside Z163 or Z164 for the same patient encounter is a common error; the code must reflect the total number of lesions removed during the session.
- Failure to document the specific clinical suspicion of malignancy in the patient chart is the most frequent cause of claim rejection during post-payment audits.
Billing Tips
- Always append E542 to your claim if the procedure is performed in a clinic or office setting rather than a hospital to capture the additional $11.55 premium.
- Ensure the clinical indication (e.g., 'suspicious for melanoma' or 'recurrent irritation') is explicitly noted in the medical record to justify the procedure as a medically necessary service rather than a cosmetic one.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
The medical record must document the clinical suspicion of disease or malignancy to support medical necessity, as removal for purely cosmetic purposes is not an insured service.
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.
Tattoo removal - (see Appendix D Surface Pathology Section 3).
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