G396 – Injections of extensive keloids
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
No specific description for billing code G396 is provided in the given context. As a 'G' prefix code, it falls under the 'Diagnostic and Therapeutic Procedures' category. General payment rules and common/specific elements of services from the General Preamble (-) apply. It is not bundled with the W010 monthly management fee and has restrictions when billed with counselling services.
When to Use
- Use G396 specifically for intralesional injections of extensive keloids where the surface area or number of lesions requires a more involved procedure than a standard minor injection.
- Use this code when performing therapeutic injections into keloid tissue to reduce hypertrophy, distinguishing it from simple diagnostic procedures or minor skin tag removals.
Common Pitfalls
- Billing G396 on the same day as K013, K033, K040, or K041 will result in an automatic rejection due to the restriction on counselling services.
- Attempting to bill G396 in conjunction with a minor assessment code (A007) may trigger audit flags if the clinical notes do not clearly separate the assessment from the therapeutic procedure.
Billing Tips
- If the keloid injection is performed under general anesthesia, ensure you append the Z455 add-on code to capture the additional complexity of the service.
- Ensure the clinical record explicitly describes the 'extensive' nature of the keloids to justify the use of G396 over less specific injection codes.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
All insured services must be documented in appropriate records that establish the service was provided, is the service for which the account is submitted, and was medically necessary, as per general requirements.
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