G811 – Keratometry, professional component
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Keratometry is the measurement of the central 4mm of the cornea for the purpose of assessing patients: - a. with irregular astigmatism resulting from scarring due to trauma, herpes simplex keratitis, dystrophies (such as Salzman's and map-dot-fingerprint dystrophy) or other inflammatory disorders; or - b. with keratoconus, pellucid marginal degeneration, keratoglobus, following penetrating keratoplasties or following pterygium excision, or - c. with corneal thinning or ectasia where corneal cross linking is being contemplated or has been performed.
When to Use
- Use G811 when performing keratometry to monitor progression in patients with diagnosed keratoconus or pellucid marginal degeneration.
- Use G811 for patients requiring corneal curvature assessment following a penetrating keratoplasty or pterygium excision to evaluate post-operative astigmatism.
- Use G811 to document corneal thinning or ectasia in patients being evaluated for corneal cross-linking procedures.
Common Pitfalls
- Billing G811 for routine refractive astigmatism or standard contact lens fittings is an ineligible service and will trigger an audit.
- Submitting G811 on the same day as G810 (corneal topography) for the same clinical indication is considered redundant and will result in a rejection.
- Failing to document the specific underlying pathology (e.g., keratoconus or post-traumatic scarring) in the clinical record will lead to recovery of funds during a Ministry audit.
Billing Tips
- Ensure the referring physician's name and billing number are clearly documented in the patient chart to satisfy the mandatory referral requirement for this diagnostic procedure.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Diagnostic
Diagnostic and Therapeutic Procedures
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