G247 – Hospital visits
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G247 is only eligible for payment to the physician most responsible, or to a physician substituting for the physician most responsible, for providing management and supervision of a: 1. Continuous catheter infusion for analgesia for a hospital in-patient; or 2. Lumbar sub-arachnoid drainage catheter placed in association with a surgical procedure where there is increased risk of spinal cord ischemia. Commentary: G247 is not for visits to patients solely receiving intravenous pain management, such as patient controlled analgesia alone; a continuous nerve/plexus block or epidural/spinal catheter must be present for G247 to be payable.
When to Use
- Use G247 for daily management of an epidural or peripheral nerve catheter providing continuous analgesia for an inpatient.
- Use G247 for monitoring a lumbar sub-arachnoid drainage catheter specifically placed to prevent spinal cord ischemia following complex vascular or thoracic surgery.
Common Pitfalls
- Billing G247 for patients managed solely on intravenous Patient Controlled Analgesia (PCA) will result in rejection, as a physical catheter is required.
- Exceeding the maximum of 3 claims per patient per day will trigger an automatic rejection or audit flag.
- Billing G247 in conjunction with standard hospital visit codes like A007 is often flagged as duplicate service; G247 is intended to capture the specialized management of the infusion.
Billing Tips
- Always append E402 or E403 premiums to G247 when services are rendered outside of standard daytime hours to maximize the value of the management fee.
- Ensure the clinical note explicitly references the presence and status of the catheter to satisfy audit requirements for the G247 management fee.
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