G213 – Physical urticaria challenges
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Physical urticaria challenges - to include at least 3 of the following: - a. assessment of dermographic challenge with 100, 250 or 500 gm needle, measuring immediate and delayed responses, - b. assessment of pressure challenge with 15 lbs. weight recording onset, peak, duration of response - immediate and delayed, - c. assessment of ice cube cold challenges, - d. assessment of cholinergic exercise challenge with use of treadmill or bicycle to target pulse rate greater or equal to 120 per minute and profuse sweating, - e. vibration effect of light and water, - f. histamine or methacholine
When to Use
- Use G213 when performing a comprehensive diagnostic workup for suspected physical urticaria that requires at least three distinct provocation tests, such as dermographic, pressure, and ice cube challenges.
- Select G213 instead of a standard office visit code (A007) when the primary purpose of the encounter is the execution of these specific physical provocation procedures.
Common Pitfalls
- Billing G213 without documenting the specific results for at least three of the six listed challenge categories will lead to automatic rejection or recovery upon audit.
- Attempting to bill G213 alongside other allergy testing codes (like G005) for the same patient encounter may trigger a conflict if the services are not clearly distinct and medically necessary.
Billing Tips
- Ensure your clinical notes explicitly list the three challenges performed and the specific physiological responses observed to satisfy the J5:405 documentation requirement.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The service must include at least 3 of the specified challenges. The type of challenges performed and their results must be documented in the patient's medical record.
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