G236 – Percutaneous lumbar, thoracic or sacral sympathetic nerve block with fluoroscopic guidance
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
A percutaneous injection to block the lumbar, thoracic, or sacral sympathetic nerves. This procedure is performed either unilaterally or bilaterally and requires the use of fluoroscopic guidance. Payment for this service includes all common elements of insured services such as obtaining history, maintaining medical records, and providing prescriptions if needed, as outlined in the Schedule of Benefits (-).
When to Use
- Use G236 for targeted sympathetic chain blockade in patients with complex regional pain syndrome (CRPS) or sympathetically maintained pain when fluoroscopic visualization of the needle tip and contrast spread is essential.
- Select G236 when performing a diagnostic or therapeutic lumbar sympathetic block, provided the procedure is distinct from any concurrent epidural or peripheral nerve blocks (e.g., G234 or G233).
Common Pitfalls
- Billing G236 as a secondary procedure when a sympathetic block is merely an incidental effect of a spinal, epidural, or plexus block, which is explicitly prohibited by the Schedule.
- Exceeding the 12-procedure limit per 12-month period without obtaining prior written authorization from the Ministry of Health, leading to automatic claim rejections.
- Failing to document the specific fluoroscopic findings, which is a mandatory requirement for audit compliance and claim validation.
Billing Tips
- Apply the E445 add-on code to increase the G236 fee by 50% if you are utilizing alcohol or other sclerosing agents for neurolytic sympathetic blockade.
- Ensure that if you bill G236 alongside other injection codes on the same day, your clinical notes explicitly state that the procedures address separate, distinct anatomical conditions to avoid rejection for duplicate service.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
Fluoroscopic guidance must be used and documented.
If billed on the same day as other nerve block or injection services, the medical record must document that this procedure was for a separate condition.
For services exceeding the frequency limit, documentation supporting the medical necessity for prior authorization from the MOH is required.
G236 is limited to a maximum of one per patient per day to a limit of 12 per patient per 12 month period. If, in the opinion of the treating physician, more frequent treatments are necessary, the physician may obtain written prior authorization from the MOH. Authorization will be dependent on the physician demonstrating that the increased frequency of the service is generally accepted as necessary for the patient under the circumstances.
G236 is only eligible for payment same patient same day with other nerve block and/or injection services if rendered to diagnose or treat a separate condition.
The sympathetic block that may result from epidural, spinal, plexus and peripheral nerve blocks is not payable as G920, G234 or G236.
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