G513 – Pentagastrin stimulation for calcitonin
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Pentagastrin stimulation for calcitonin is a diagnostic procedure listed in the Endocrinology and Metabolism subsection of the Schedule. The service includes all common and constituent elements of an insured service as outlined in the Schedule of Benefits (, ).
When to Use
- Use G513 specifically for the administration and monitoring of a pentagastrin stimulation test to assess calcitonin levels in patients suspected of medullary thyroid carcinoma.
- Select G513 when performing the diagnostic procedure in an office or hospital setting where the physician is directly supervising the administration and subsequent blood sampling.
Common Pitfalls
- Billing G513 in conjunction with a consultation or assessment code (A-prefix) for the same patient on the same day is a common cause of rejection, as the procedure fee is intended to be comprehensive.
- Failing to document the specific timing of the blood draws and the administration of the pentagastrin agent often leads to audit recovery, as the Ministry requires evidence of the diagnostic protocol.
Billing Tips
- Ensure the diagnostic code (ICD-9) reflects the underlying endocrine condition, such as thyroid neoplasm, to justify the medical necessity of the stimulation test.
- If the procedure is performed in an ICU or CCU setting, append the C101 premium to G513 to capture the additional complexity of the patient environment.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The clinical decision(s) formulated by the physician or substitute physician may be communicated to the patient, patient's relative, patient's representative or other caregiver by a staff member other than the physician.
Month refers to a calendar month.
If G514 and G520 are claimed in the same month by the same physician for the same patient, the total fee eligible for payment will be adjusted to the value of G520.
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