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G005
G005 – Pregnancy test
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
A laboratory medicine test to determine pregnancy. As a 'simple office laboratory procedure', this service can be delegated to a physician's employee in the physician's office. For delegation requirements, refer to pages and of the Schedule. This service is considered a component of the monthly management fee (W010) for patients in a nursing home or home for the aged and is not separately payable in that context.
When to Use
- Use G005 when performing an in-office urine pregnancy test to confirm suspected pregnancy for a patient presenting with amenorrhea or related symptoms.
- Use G005 for diagnostic confirmation when a patient presents with abdominal pain or vaginal bleeding to rule out ectopic pregnancy or miscarriage in an office setting.
Common Pitfalls
- Billing G005 for patients residing in a nursing home or home for the aged will result in automatic rejection because it is bundled into the W010 monthly management fee.
- Submitting G005 in addition to a comprehensive assessment code (like A007) is acceptable, but ensure the pregnancy test is medically necessary and documented as a distinct diagnostic procedure performed that day.
Billing Tips
- Since G005 is a delegated procedure, ensure your office staff documentation clearly indicates the test was performed in the office to justify the fee if audited.
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