G402 – Critical care - 31st day onwards
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. As a 'G' code, it is classified as a Diagnostic and Therapeutic Procedure. General Preamble rules apply, including the requirement for medical necessity and appropriate documentation in the patient's medical record as described on page . This service must be rendered personally by the physician as it is not listed as a delegatable procedure on page .
When to Use
- Use G402 for daily management of a critically ill patient in an ICU setting who has surpassed the 30-day threshold of critical care billing.
- Apply this code when the patient is not receiving ventilatory support but remains in an ICU requiring intensive, physician-led management that exceeds standard daily assessment criteria.
Common Pitfalls
- Billing G402 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 claim After Hours Procedure Premiums (E409/E410) with G402, which will result in automatic rejection as it is not an eligible Major Invasive Procedure.
- Failing to account for the transfer rule where a patient moved from comprehensive care to critical care must be billed as the second day of critical care.
Billing Tips
- Ensure your documentation clearly reflects the 'critical' nature of the illness and the specific intensive interventions provided, as G402 is subject to audit for medical necessity.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The specific listing, notes, and description for G402 are located on page of the Schedule of Benefits.
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