G401 – Critical Care - 2nd to 30th 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). This code specifically applies to the 2nd to 30th day, inclusive, of critical care. 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 G401 for patients in an Intensive Care Area who are hemodynamically unstable or require complex multisystem monitoring between the 2nd and 30th day of their critical care stay.
- Use G401 when the patient has been transferred from a comprehensive care unit to an ICU, as the transfer day is automatically deemed the second day of critical care for billing purposes.
- Use G401 for patients requiring active management of intracranial pressure or invasive monitoring lines who do not meet the criteria for ventilatory support codes.
Common Pitfalls
- Billing G401 for patients who are stabilized or admitted solely for ECG monitoring or observation, as these are explicitly excluded by the Schedule of Benefits.
- Attempting to bill G401 concurrently with G405, G406, or G407, which are restricted due to their association with ventilatory support.
- Failing to recognize that G401 is strictly for non-ventilated patients; if the patient requires a ventilator, you must switch to the appropriate G405-G407 series.
Billing Tips
- Ensure the patient is physically located in an Intensive Care Area, as the location is a mandatory requirement for the validity of the G401 claim.
- Document the specific clinical instability that necessitates ongoing critical care beyond the first day to justify the use of G401 over standard daily assessment codes.
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