G405 – Ventilatory support - 1st day
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Ventilatory Support includes provision of ventilatory care including initial consultation and assessment of the patient, intravenous lines, endotracheal intubation with positive pressure ventilation including insertion of arterial C.V.P lines, tracheal toilet, use of artificial ventilator and all necessary measures for its supervision, obtaining and interpretation of blood gases, oximetry, transcutaneous blood gases and assessment. If the patient has been transferred from comprehensive care to ventilatory care, the day of the transfer shall be deemed for payment purposes to be the second day of ventilatory care.
When to Use
- Use G405 for the first calendar day of mechanical ventilation, which must include the initial intubation and setup of the ventilator circuit.
- Apply this code when managing a patient requiring invasive positive pressure ventilation, encompassing the bundled care of arterial lines, central venous access, and frequent blood gas monitoring.
Common Pitfalls
- Billing G405 on the same day as a separate intubation procedure code is a duplicate claim, as intubation is explicitly included in the G405 fee.
- Failing to account for the transfer rule: if a patient moves from a comprehensive care unit to ventilatory care, the transfer day must be billed as G406 (second day) rather than G405.
- Attempting to bill separate procedure codes for arterial or central line insertions, which are considered bundled components of the G405 service.
Billing Tips
- Ensure that the date of service reflects the actual start of ventilatory support, as G405 is strictly reserved for the first day of the episode.
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.
The Act requires that the record 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.
Documentation should specifically detail the provision of ventilatory care, including initial consultation and assessment, intravenous lines, endotracheal intubation with positive pressure ventilation (including insertion of arterial C.V.P lines), tracheal toilet, use and supervision of an artificial ventilator, and the obtaining and interpretation of blood gases, oximetry, and transcutaneous blood gases.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.