G369 – B.C.G. inoculation, following tuberculin tests
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
B.C.G. inoculation. As outlined in and of the Schedule, this service is listed as a common procedure that can be delegated. When performed by a physician's employee in the physician's office, the service is insured if: - It is a generally and historically accepted procedure for delegation. - The physician is physically present in the office and immediately available to intervene, subject to certain exceptions. An exception to the physician's physical presence is permitted if the following conditions are met: - The employee is properly trained and reports to the physician. - The procedure is performed on the physician's own patient. - Specific medical record requirements are met, including dating the record, identifying the non-physician who performed the service, and including a brief note on the procedure.
When to Use
- Use G369 specifically for the administration of the BCG vaccine following a documented tuberculin skin test (e.g., G001 or G002).
- Apply this code when the procedure is performed by a qualified office employee under your direct supervision, ensuring the patient record identifies the specific staff member who administered the inoculation.
Common Pitfalls
- Billing G369 on the same day as a counselling service (e.g., K013 or K033) will result in a rejection, as G369 is not an exempted procedure under the GP58 billing rules.
- Attempting to claim G369 for a BCG vaccine administered by a public health unit nurse or a Family Health Team employee is ineligible, as the code requires the staff member to be directly employed by the billing physician.
- Adding an after-hours premium (e.g., E409) to G369 will be rejected because this procedure does not qualify as a Major Invasive Procedure under GP104.
Billing Tips
- Ensure the medical record explicitly states the date, the name of the staff member who performed the inoculation, and a brief note on the procedure to satisfy the delegation requirements outlined in GP62.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures, Delegated Procedure
When delegated, the same medical record requirements must be met as if the physician personally had rendered the service. The record must be dated, identify the non-physician performing the service, and contain a brief note on the procedure performed by the non-physician.
This service is listed in the 'Delegated Procedure' section of the General Preamble.
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