G500 – Insulin initiation or initial specialist assessment
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
This service is for the month in which insulin injections (2 or more daily) or insulin by pump is initiated; or the month in which the initial assessment by a specialist of a diabetic patient treated with insulin injections (2 or more daily) or insulin by pump occurs, requiring one or more contacts. A 'contact' is defined as the provision to a patient, patient's relative(s), patient's representative or other caregiver(s) of medical advice, direction or information by telephone or otherwise, in which a change in the frequency or dose of insulin therapy is initiated regarding a patient. In addition to the common elements (:27, :28), the components of this service include the following specific elements: A. Monitoring the condition of a patient with respect to insulin therapy, including ordering blood tests, reviewing patient's glucose self-monitoring, interpreting the results and inquiry into possible complications. B. Adjusting the type, frequency and dose of insulin therapy, and where appropriate, prescribing alternate or additional therapy. C. Discussion with, and providing advice and information to the patient, patient's relative(s), patient's representative or other caregiver(s), by telephone or otherwise, on matters related to the service, regardless of identity of person initiating discussion. D. Making arrangements for any related assessments, procedures and/or therapy and interpreting results as appropriate. E. Providing premises, equipment, supplies and personnel for the specific elements.
When to Use
- Use G500 in the calendar month you initiate a patient on a regimen of two or more daily insulin injections or an insulin pump.
- Use G500 when performing the initial specialist assessment for a patient already established on a regimen of two or more daily insulin injections or an insulin pump.
Common Pitfalls
- Billing G500 for a patient on a once-daily insulin regimen, which fails the mandatory requirement of two or more daily injections.
- Billing G500 without documenting a specific 'contact' that resulted in a documented change to the frequency or dose of the insulin therapy.
- Attempting to bill G500 on the same day as a consultation or assessment by the same physician, which is explicitly prohibited by the Schedule of Benefits.
Billing Tips
- Ensure your chart note explicitly states the change made to the insulin dose or frequency, as this is the primary audit trigger for the 'contact' requirement.
- Remember that G500 is mutually exclusive with G514 and G520; verify the patient's history to ensure you are not duplicating management fees within the same month.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
ManagementFee
Assessments, Diagnostic and Therapeutic Procedures
As with all insured services, an appropriate medical record must be kept to establish that the service was medically necessary and rendered. (:22)
The 'contact(s)' leading to a change in insulin therapy should be documented in the patient's medical record.
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