G404 – Chronic ventilatory care outside an Intensive Care Unit
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Chronic ventilatory care is the management of a patient requiring ongoing ventilation outside of an Intensive Care Unit. Per the Schedule, this service is limited to a maximum of two times per week. Additionally, if G404 is claimed for a patient on a specific day, any other consultation or assessment fee claimed by the same physician for the same patient on the same day will be reduced to nil.
When to Use
- Use G404 for the routine management of stable patients requiring long-term mechanical ventilation in a chronic care or step-down unit setting.
- Use this code when providing ongoing ventilator settings adjustments and monitoring for patients who no longer meet the criteria for ICU-level care.
Common Pitfalls
- Billing G404 more than twice in a rolling seven-day period will result in automatic rejection of the third claim.
- Claiming a subsequent visit (e.g., A007) or a consultation on the same day as G404 will trigger a zero-dollar payment for the assessment code due to the mandatory reduction rule.
- Attempting to bill G404 for patients currently admitted to an Intensive Care Unit will lead to audit scrutiny as the code explicitly excludes ICU environments.
Billing Tips
- Ensure your clinical notes clearly delineate the ventilator management component from general ward care to justify the use of this specific procedure code.
- If you must perform a comprehensive assessment on the same day as G404, prioritize billing the higher-value service, though note that the assessment will be reduced to nil regardless of which is submitted first.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
Maximum 2 per week. Any other amount payable for consultations or assessments same patient, same physician, same day will be reduced to nil.
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