Z163 – Nevus - two lesions
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Removal of two nevi (Group 2) by excision and suture. For a detailed description of Group 2 lesions (nevus), see Appendix D Surface Pathology, Section 4. Note: 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.
When to Use
- Use Z163 when performing a surgical excision and suture of exactly two distinct nevi that are clinically suspicious for malignancy or disease.
- Use this code when the clinical documentation justifies medical necessity, distinguishing it from cosmetic removal which is strictly uninsured.
Common Pitfalls
- Billing Z163 for the removal of a single nevus; you must use Z162 for one lesion, as Z163 is specifically for two.
- Failing to document the specific clinical suspicion (e.g., change in size, irregular borders, bleeding) which leads to automatic rejection during post-payment audits.
- Attempting to bill Z163 alongside other excision codes for the same anatomical site without proper documentation of separate, distinct procedures.
Billing Tips
- Ensure the medical record clearly identifies the anatomical location of both nevi to support the claim for two lesions.
- If the procedure is performed in an office setting, remember to append the E542 premium to the Z163 claim to capture the additional fee.
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 the medical necessity of the excision, as cosmetic removal is an uninsured 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.
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