G422 – Retrobulbar injection
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Retrobulbar injection for diagnostic or therapeutic purposes. Per the Schedule, this service is not to be claimed when used as a local anaesthesia (). The General Preamble further clarifies that when a physician administers an anaesthetic, nerve block, and/or other medication in conjunction with a diagnostic, therapeutic, or surgical procedure they perform on the same patient, the administration of the anaesthetic or nerve block is not eligible for payment (:114).
When to Use
- Use G422 for therapeutic retrobulbar injections of corticosteroids or other medications intended to treat orbital inflammatory conditions or specific ocular pathologies.
- Use G422 when performing a diagnostic retrobulbar injection to assess nerve function or orbital pressure, provided it is not part of a surgical procedure performed by the same physician.
Common Pitfalls
- Claiming G422 for retrobulbar blocks administered as local anesthesia for cataract or other ocular surgeries will result in automatic rejection under GP100:114.
- Billing G422 alongside a surgical procedure code performed by the same physician is a direct violation of the General Preamble regarding inclusive anesthetic administration.
Billing Tips
- Ensure the clinical record clearly distinguishes the therapeutic intent of the injection from any local anesthetic requirements to avoid audit flags related to J81 usage.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
Not to be claimed when used as a local anaesthesia
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