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G365
G365 – Collection of cervical cancer screening specimen(s)
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Payable for the collection of cervical cancer screening specimen(s). This service is eligible for an add-on premium, E430, when the specimen(s) are collected outside of a hospital or Integrated Community Health Services Centre (ICHSC). This service is a component of the W010 monthly management fee for patients in a nursing home or home for the aged and is not separately payable when W010 is claimed. It can be billed on the same day as counselling services as per .
When to Use
- Use G365 when the primary purpose of the visit is the collection of a Pap smear specimen in a community office setting.
- Bill G365 alongside E430 when the collection occurs in your private office to capture the additional $11.95 premium.
- Use G365 for opportunistic screening during a visit that is not a comprehensive assessment, provided the pelvic exam is not a mandatory component of that specific service.
Common Pitfalls
- Billing G365 on the same day as a general or specific assessment (e.g., A007, A005) will result in a rejection because the pelvic exam is considered part of the assessment fee.
- Claiming G365 for patients in a nursing home is a common audit trigger, as it is bundled into the W010 monthly management fee.
- Attempting to bill G365 alongside a colposcopy service will lead to automatic rejection due to the same-day restriction.
Billing Tips
- Always append E430 to your G365 claim for office-based collections to ensure you are compensated for the specimen handling and processing requirements.
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