Z188 – Complex laceration repair, anatomical area other than face
OHIP Psychiatric Code — INTEGUMENTARY SYSTEM SURGICAL PROCEDURES · Schedule of Benefits
A complex laceration repair of an anatomical area other than face (except zone 1 repair of digit) is a repair that requires a minimum of 20 minutes of time to perform the repair procedure and at least one of the following: - closure of three or more layers (muscle sheath, subcutaneous tissue, skin etc.); or - ligation of multiple bleeding vessels.
When to Use
- Use for deep lacerations on the trunk or extremities requiring three-layer closure (e.g., muscle, fascia, and skin) that take at least 20 minutes to complete.
- Use when a wound requires the ligation of multiple bleeding vessels to achieve hemostasis, provided the procedure duration meets the 20-minute minimum threshold.
Common Pitfalls
- Billing Z188 for simple skin-only closures; if the repair does not involve three layers or significant vessel ligation, it should be billed as a simple repair (Z187).
- Failing to document the start and end time of the procedure, which is a mandatory requirement to justify the 20-minute minimum for the 'complex' designation.
- Attempting to bill Z188 for facial lacerations, which are explicitly excluded; facial repairs must be billed under the appropriate facial laceration codes.
Billing Tips
- Ensure the operative note explicitly lists the layers closed (e.g., 'deep fascia, subcutaneous tissue, and dermis') to satisfy the three-layer requirement during an audit.
- If you use tissue adhesives like Dermabond, remember that the OHIP Schedule of Benefits mandates a 50% reduction in the fee, regardless of the complexity of the wound.
Effective: April 1, 2026
M. Integumentary System Surgical Procedures
INTEGUMENTARY SYSTEM SURGICAL PROCEDURES
Surgical
Integumentary System Surgical Procedures
The medical record must document that the repair procedure required a minimum of 20 minutes of time.
The medical record must document at least one of the following criteria was met: - closure of three or more layers (muscle sheath, subcutaneous tissue, skin etc.) - ligation of multiple bleeding vessels
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