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G823
G823 – OCT unilateral or bilateral - evaluation of an infant/child/adolescent with retinal disease and/or glaucoma
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
OCT unilateral or bilateral - evaluation of an infant/child/adolescent with retinal disease and/or glaucoma (including genetic retinal anomalies and cancer), or low vision associated with or resulting in developmental delay when the physician interprets the results and either performs the procedure or supervises the performance of the procedure on a patient younger than 18 years of age.
When to Use
- Use G823 for OCT imaging in patients under 18 years old specifically diagnosed with glaucoma or retinal pathologies like retinopathy of prematurity or genetic retinal dystrophy.
- Use this code for pediatric patients presenting with low vision secondary to developmental delay where OCT is required to assess structural integrity.
- Select G823 over G818 or G820 when the clinical focus is pediatric retinal disease or pediatric glaucoma management.
Common Pitfalls
- Billing G823 for patients who have reached their 18th birthday will result in an automatic rejection; use the appropriate adult OCT codes (G818, G820, G821, G822) instead.
- Attempting to claim G823 in conjunction with other OCT codes (G818, G820, G821, G822) on the same day is prohibited and will trigger a payment denial.
- Failure to document the specific retinal disease or glaucoma diagnosis in the patient chart creates an audit risk, as the code is strictly restricted to these clinical indications.
Billing Tips
- Ensure the patient's age is verified at the time of service, as G823 is the exclusive OCT code for the pediatric population under 18 years of age.
- Always include the relevant diagnostic code for the retinal disease or glaucoma to support the medical necessity of the OCT procedure during OHIP audits.
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