E030C – Procedural sedation
OHIP Surgical Assists Code — GENERAL PREAMBLE · Schedule of Benefits
When a physician renders an anaesthesia service in support of services performed by another physician listed in Nerve Blocks for Acute Pain Management, Interventional Pain Injections or the Peripheral/Other Nerve Block sections of the Schedule the anaesthesia service is only eligible for payment as E030C for procedural sedation. Procedural Sedation is defined as a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
When to Use
- Use E030C when providing procedural sedation for patients undergoing interventional pain injections or nerve blocks where the primary physician is performing the procedure.
- Use this code specifically when the patient remains responsive to verbal commands and light tactile stimulation, as it is strictly defined as procedural sedation rather than general anaesthesia.
Common Pitfalls
- Billing E030C alongside any of the restricted anaesthesia codes (e.g., E021C, E014C, E009C) will result in an automatic rejection.
- Attempting to claim additional time units or 'extra units' listed in GP97 is prohibited with E030C and will lead to claim adjustments or audit flags.
- Submitting Z432C for anaesthesia support during a nerve block is ineligible; E030C is the exclusive code for this support service.
Billing Tips
- Ensure you append the appropriate after-hours or night premiums (E400C or E401C) to E030C if the procedure commences during the specified time windows to maximize the claim value.
- When travelling to the hospital for these procedures, always include the relevant Special Visit Premium (C998C, C985C, or C999C) as they are payable in addition to E030C.
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