G400 – Critical Care - 1st day
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Critical Care is the service rendered by a physician for providing, in an Intensive Care Area, all aspects of care of a critically ill patient excluding ventilatory support and includes initial consultation and assessment, emergency resuscitation, intravenous lines, cutdowns, intraosseous infusion, pressure infusion sets and pharmacological agents, insertion of arterial, C.V.P. or urinary catheters and nasogastric intubation with or without anaesthesia, securing and interpretation of laboratory tests, oximetry, transcutaneous blood gases, and intracranial pressure monitoring interpretation and assessment when indicated (excluding insertion of I.C.P. measuring device). Except when a patient is on a ventilator, these fees are not payable for services rendered to stabilized patients in I.C.U.s, or patients admitted for ECG monitoring or observation alone. If the patient has been transferred from comprehensive care to critical care, the day of the transfer shall be deemed for payment purposes to be the second day of critical care.
When to Use
- Use G400 for the first day of active management of a critically ill patient in an ICU setting who does not require mechanical ventilation.
- Use G400 when performing complex procedures like arterial or CVP line insertion during the initial stabilization phase of a critically ill patient, as these are included in the fee.
- Use G400 when a patient is transferred from a general ward to an ICU for active critical care management, as this counts as the first day of the G400 service.
Common Pitfalls
- Billing G400 for patients admitted solely for cardiac monitoring or observation, which is explicitly excluded by the Schedule of Benefits.
- Attempting to claim after-hours premiums (E409, E410, E412, E413) or trauma premiums (E420), which are ineligible because G400 is a Section J code.
- Billing G400 concurrently with other procedural codes for tasks already included in the G400 definition, such as nasogastric intubation or urinary catheter insertion.
Billing Tips
- Ensure the patient is not on a ventilator; if mechanical ventilation is initiated, you must switch to the G401/G402 series instead of G400.
- Document the specific clinical instability that necessitates critical care, as 'observation' or 'monitoring' alone will trigger a rejection or audit recovery.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
All insured services must be documented in appropriate records that establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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