E542, Q015 & IUDs: Which Procedure Codes Can You Bill Together?
In-office procedures follow a consistent pattern in OHIP billing: they combine freely with assessments, they carry a tray fee in defined circumstances, and they never combine with counselling codes.
Here are the five procedure combination questions that come up most.
1. Procedures and counselling codes (almost) never mix
Every procedure in the family medicine schedule carries the same exclusion: K013 and K033 cannot be billed with most of them.
That includes cryotherapy (Z117, Z119), IUD insertion and removal (G378, G552), endometrial biopsy (Z770), the Epley maneuver (G403), ear syringing (G420), incision and drainage (Z101), and joint injections (G370, G371).
However, K013 and K033 can be billed with paps (G365/G394) without the tray fee, as well as venipuncture and vaccines.
The flip side is more useful: procedures combine with any other A or K code. A patient in for an intermediate assessment who also needs a joint injection is a clean A007 + G370 + E542 claim.
2. E542: When the tray fee applies
The E542 tray fee attaches to a specific list of procedures, not to procedures generally. It applies to:
- Joint, bursa, and ganglion aspirations and injections
- IUD insertion and removal
- Endometrial biopsy
- Foreign body removal
- Excisions, biopsies, and debridement
- Incision and drainage
- Laceration repair
Note that E542 is the procedure tray. The pap trays are different codes: E430 for a normal pap and E431 for an abnormal or follow-up pap. Substituting one for the other is a quiet rejection, since the claim often pays at the wrong rate rather than failing outright.
3. IUD insertion and removal can't be billed on the same day
G378 (insertion) and G552 (removal) are mutually exclusive on a single claim. If you're removing one IUD and inserting another in the same visit, you cannot bill both.
Both carry the E542 tray fee, both exclude K013/K033, and neither is eligible for the after-hours bonus Q012.
4. Q015: The code that must be billed with A007, and only A007
Q015 (Newborn Episodic) is unusual: it cannot be billed with any service other than A007. Not A001, not A003, not a periodic health exam. The Intermediate Assessment is the only compatible partner.
Read from the other direction, the matrix is explicit: if you're billing Q015, you must bill A007.
- Maximum 8 per patient under age 1
- Vaccines can be billed alongside
5. Cryotherapy: The lesion count changes the code
Z117 covers 1 to 4 lesions. Z119 covers 5 or more, and carries site restrictions: plantar, perianal, genital, or head and neck if the patient is under 18.
The fee difference between the two is substantial, and defaulting to Z117 out of habit on a multi-lesion visit is one of the easier ways to under-bill a procedure. Neither is eligible for the after-hours bonus.
A note on delegated procedures
Several procedures can be delegated to a nurse, including ear syringing (G420), spirometry, casts, UV light therapy, oral polio vaccine, and BCG inoculation. The billing condition is specific: you can only bill for a delegated procedure if the nurse is directly employed by you.
For G420 specifically, the clinical indication also matters: hearing loss or the need to visualize the tympanic membrane.
Optimize your combinations
Which tray code attaches to which procedure, which procedures exclude counselling, when the lesion count changes the code: Quip checks all of it automatically before your claim leaves the EMR.
Calculate how much your mistakes are costing you. Try Quip for free to see how Quip flags procedure combinations in real time, right inside PS Suite or Accuro.
Quip Medical builds AI-powered OHIP billing optimization for Ontario physicians. This post reflects billing rules as of August 2026; always confirm current requirements with the OMA Schedule of Benefits.