Z164 – Nevus - three or more lesions
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
Removal by excision and suture of three or more nevi. This procedure is classified under Group 2 lesions (nevus) as described in Appendix D, Section 4 of the Schedule of Benefits. Payment is conditional upon the service being medically necessary, meaning there is a clinical suspicion of disease or malignancy. Removal for purely cosmetic reasons is an uninsured service. An add-on premium, E542, is applicable when performed outside a hospital.
When to Use
- Use Z164 when you perform a surgical excision and suture of three or more nevi during a single encounter for patients where malignancy is clinically suspected.
- Use this code when the clinical presentation warrants excision for diagnostic purposes (e.g., changing morphology, bleeding, or rapid growth) rather than simple shave biopsy.
- Use Z164 specifically when the total count of excised nevi is three or more; do not use this code for single or double lesions, which fall under Z162 or Z163.
Common Pitfalls
- Billing Z164 for cosmetic removal of benign nevi is a common audit trigger; ensure the medical record explicitly documents the clinical suspicion of malignancy or disease.
- Submitting Z164 for multiple lesions that were removed via shave or cautery rather than excision and suture will lead to rejections or recovery during audits.
- Failing to append the E542 premium when the procedure is performed in a physician's office results in underpayment, as this is not automatically applied by the system.
Billing Tips
- Always document the specific clinical indication for each lesion removed to justify the medical necessity of the excision.
- Ensure the E542 premium is included on the same claim as Z164 when the procedure is performed in an office setting to capture the full allowable fee.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
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.
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