G522 – Life threatening critical care - after first ½ hour
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G522 represents each quarter-hour (or part thereof) of life-threatening critical care provided by a physician after the initial 30 minutes (billed as G521 and G523). This service is rendered when a physician provides critical care to a critically ill or critically injured patient. For the purpose of this service, a critical illness or critical injury is one that acutely impairs one or more vital organ system(s) causing vital organ system failure as a result of which imminent life threatening deterioration in the patient's condition is highly probable. The physician's time must be fully devoted to the patient's care at the bedside, in the emergency department, or on the hospital floor. Time can be counted consecutively or non-consecutively.
When to Use
- Use G522 for every 15-minute block of bedside critical care after the initial 30 minutes covered by G521 or G523 have been exhausted.
- Apply this code when managing patients with acute multi-organ system failure, such as septic shock requiring continuous vasopressor titration and hemodynamic monitoring.
- Utilize G522 during prolonged resuscitation efforts where the physician must remain at the bedside to manage life-threatening instability that precludes seeing other patients.
Common Pitfalls
- Billing G522 concurrently with routine procedures like intravenous line insertion or endotracheal intubation, which are considered inclusive of the critical care service.
- Failing to document the exact start and end times for the critical care period, which is a mandatory audit requirement for G522.
- Attempting to bill G522 while simultaneously claiming A384 or K181, which are strictly restricted during the time reported for critical care.
Billing Tips
- Ensure the total time claimed for G522 is calculated only after the first 30 minutes of G521/G523 are fully accounted for.
- If the patient meets trauma criteria, append the E420 trauma premium to G522 on the same claim, provided the Injury Severity Score is explicitly documented in the chart.
Effective: April 1, 2026
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
The physician must record on the patient's permanent medical record or chart the time when the insured service started and ended.
For the Trauma Premium (E420) to be payable, the medical record must list the Injury Severity Score (ISS).
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