G395 – Other critical care - first 1/4 hour
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
The service rendered when a physician provides resuscitation assessment and procedures in an emergency in circumstances other than those described as 'life threatening critical care', where there is a potential threat to life or limb of such a type that without resuscitation efforts by the physician, there is a high probability the patient will suffer loss of limb or require 'life threatening critical care'. This fee code covers the first ¼ hour (or part thereof) of this service. Amount payable per physician per patient for the first three physicians. The subsequent quarter-hours are billed using G391.
When to Use
- Use for active resuscitation of a patient with severe sepsis or unstable GI bleed where the patient is not yet in full 'life-threatening' shock but requires immediate intervention to prevent progression.
- Use for managing a patient with a severe, limb-threatening vascular compromise or compartment syndrome requiring immediate procedural stabilization.
- Use when providing intensive, continuous bedside care to a patient with acute respiratory distress who does not yet meet the criteria for full life-threatening critical care (G521-G523).
Common Pitfalls
- Billing G395 concurrently with routine procedures like IV insertion, urinary catheterization, or blood gas analysis, which are explicitly bundled into the critical care fee.
- Failing to document the exact start and end times, which leads to automatic rejection or clawback during an audit.
- Attempting to bill G395 alongside G521-G523; these codes are mutually exclusive and represent different tiers of severity.
Billing Tips
- Ensure you bill G391 for every subsequent 15-minute block beyond the initial G395 to capture the full duration of the critical care provided.
- If the patient meets trauma criteria, append the E420 trauma premium to the G395 claim to increase the fee by 50%, provided the ISS score is documented.
Effective: April 1, 2026
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended. If the patient's permanent medical record or chart does not include this required information, the service is not eligible for payment.
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