G512 – Palliative care case management fee
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
This service is for the supervision of palliative care for a patient for a one-week period, commencing at midnight Sunday. It includes the following specific elements:
- A. Monitoring the condition of a patient including ordering tests and interpreting test results.
- B. Discussion with and providing telephone advice to the patient, patient's family or patient's representative even if initiated by the patient, patient's family or patient's representative.
- C. Arranging for assessments, procedures or therapy and coordinating community and hospital care including but not limited to urgent rescue palliative radiation therapy or chemotherapy, blood transfusions, paracentesis/thoracentesis, intravenous or subcutaneous therapy.
- D. Providing premises, equipment, supplies and personnel for all elements of the service.
When to Use
- Use G512 when you are the most responsible physician coordinating weekly care for a terminal patient, including phone consultations with family or home care agencies.
- Use this code when managing complex symptom titration, such as adjusting subcutaneous infusions or coordinating urgent palliative procedures like paracentesis, provided you are not billing G511, K071, or K072 for that same week.
Common Pitfalls
- Billing G512 in the same week as G511, K071, or K072 will trigger an automatic rejection, as these codes are mutually exclusive.
- Claiming G512 when you are not the most responsible physician or when you have not provided the majority of care during a transfer week will result in audit recovery.
- Attempting to bill G512 for patients who do not meet the strict definition of being in the final year of life with a focus on comfort rather than curative treatment.
Billing Tips
- You may continue to bill for face-to-face assessments, subsequent visit fees, and K023 alongside G512, as these are not restricted by the management fee.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
ManagementFee
Diagnostic and Therapeutic Procedures
The service is only eligible for payment when rendered by the physician most responsible for the patient's care, or by a physician substituting for this physician.
G511, K071 or K072 are not eligible for payment to any physician when rendered during a week that G512 is rendered.
G512 is limited to a maximum of one per week (Monday to Sunday inclusive) per patient and, in the instance a patient is transferred from one most responsible physician to another, is only eligible for payment to the physician who rendered the service the majority of the week.
In the event of the death of the patient or where care commences on any day of the week, G512 is eligible for payment even if the service was not provided for the entire week.
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