G011 – Fungus culture including KOH preparation and smear
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Fungus culture including KOH preparation and smear. As per , this is a simple office laboratory procedure that may be delegated to a physician's employee under the conditions outlined in . This service is also listed as a component of the W010 monthly management fee for patients in a nursing home or home for the aged, and is not separately payable in that context as per .
When to Use
- Use G011 when you perform an in-office KOH preparation and fungal culture for suspected dermatophytosis, such as tinea pedis or onychomycosis.
- Choose G011 for diagnostic confirmation of fungal skin infections when the clinical presentation is ambiguous and requires laboratory verification rather than empirical treatment.
Common Pitfalls
- Billing G011 for patients in a nursing home or home for the aged will result in an automatic rejection if you have already claimed the W010 monthly management fee for that month.
- Failing to document the specific name of the staff member who performed the procedure will lead to audit recovery if the service was delegated under GP62 guidelines.
Billing Tips
- Ensure the laboratory procedure is distinct from a standard office visit; you may bill an assessment code (e.g., A007) in addition to G011 if a full clinical examination is performed during the same encounter.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Laboratory
Diagnostic and Therapeutic Procedures, Delegated Procedure
If delegated to a non-physician, the medical record must be dated, identify the non-physician performing the service, and contain a brief note on the procedure performed.
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