G112 – Dipyramidole Thallium stress test - professional component
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Professional component for a Dipyramidole Thallium stress test. This service is part of a maximal stress ECG (to exhaustion, symptoms or ECG changes) or submaximal stress ECG (to target heart rate) by a standard technique with Dipyridamole Thallium. It includes oscilloscopic continuous monitoring, ECGs taken during the procedure, and resting ECGs before and after. The physician must be in attendance at all times. The professional component includes the necessary clinical assessment immediately prior to testing. The technical component is billed separately using billing code G111.
When to Use
- Use G112 when performing the professional supervision and interpretation of a pharmacologic stress test using Dipyridamole for patients unable to achieve target heart rate via exercise.
- Use this code for symptomatic patients requiring diagnostic evaluation for suspected coronary artery disease where standard treadmill testing (G315/G319) is contraindicated or physically impossible.
Common Pitfalls
- Billing G112 for routine preoperative cardiac clearance in low-risk surgical patients will trigger automatic rejections or audit flags per the Schedule of Benefits.
- Submitting G112 for asymptomatic patients with a Framingham 10-year risk score under 10% is considered an uninsured service and will lead to claim denial.
- Failure to ensure the technical component (G111) is billed by the facility or the appropriate provider can lead to reconciliation issues during audit.
Billing Tips
- Ensure your documentation explicitly justifies the clinical necessity of the pharmacologic agent (Dipyridamole) over standard exercise stress testing to satisfy potential audit inquiries regarding the choice of procedure.
- Confirm that the patient's risk profile (Framingham score or equivalent) is documented in the chart to support the medical necessity of the test if requested by the Ministry.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Diagnostic
Diagnostic and Therapeutic Procedures
1. The technical and professional fee components for maximal stress ECG are not eligible for payment in the routine preoperative preparation or screening of a patient for surgery where the patient will undergo a low risk procedure or has a low risk of perioperative cardiac complications, unless there is a clinical indication requiring a exercise stress test study other than solely for preoperative preparation of the patient.
2. G315, G319, G174, G111 and G112 are uninsured services for routine annual stress tests in asymptomatic patients where the patient's 10 year risk of coronary heart disease is less than 10% calculated by generally accepted methodology.
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