G098 – Transfusion support
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
The service rendered for transfusion support, iron overload management and Sickle Cell crisis management and prevention related to Sickle Cell Disease, Thalassemia or transfusion dependent Congenital Hemolytic Anemia. The service includes routine outpatient visits (including, for example, supervised blood transfusions, iron chelation therapy, monitoring of complications of iron overload, pain management of acute or chronic Sickle Cell Disease) and any counselling/psychotherapy/genetic counselling of the patient, the patient's relatives or their representatives. The specific elements of this service are all services performed by the specialist in charge of the patient during a one-week period in providing non-emergency care to the patient, including providing any advice whether by telephone or otherwise and even when initiated by the patient, patient's relative(s), or their representative(s) and including providing all premises, equipment, supplies and personnel used by the specialist in charge of the patient to perform these services.
When to Use
- Use G098 as a weekly management fee for stable patients receiving routine outpatient iron chelation therapy or regular blood transfusions for Thalassemia or Sickle Cell Disease.
- Apply this code for ongoing outpatient monitoring of iron overload complications or routine pain management for chronic Sickle Cell Disease when no other assessment codes are billed for that week.
Common Pitfalls
- Billing G098 in the same week as a hospital admission or inpatient assessment code will trigger an automatic rejection as it is strictly an outpatient management fee.
- Attempting to bill individual office visit codes (e.g., A007) in addition to G098 for the same patient within the same seven-day period is prohibited, as G098 is designed to be all-inclusive.
- Submitting G098 for patients who do not have a documented diagnosis of Sickle Cell Disease, Thalassemia, or transfusion-dependent Congenital Hemolytic Anemia will result in audit recovery.
Billing Tips
- Since G098 covers all services rendered in a one-week period, ensure your billing software tracks the seven-day window to avoid duplicate submissions or missed claims.
- If an emergency visit occurs during the week, bill the appropriate emergency visit code and premiums separately, as these are specifically excluded from the G098 inclusive definition.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
ManagementFee
Diagnostic and Therapeutic Procedures
When physicians are required to make emergency visits, the appropriate visits and premiums are eligible for payment.
When the patient requires hospitalization, the appropriate fees for in-patient services are eligible for payment instead of G098.
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