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G557
G557 – Critical care - 1st day
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
When to Use
- Use G557 on the first calendar day a patient is admitted to a designated ICU or CCU and requires the physician-in-charge to provide comprehensive, continuous critical care management.
- Apply this code when the patient's clinical status necessitates constant monitoring and intervention that exceeds the scope of a standard subsequent hospital visit (C002).
Common Pitfalls
- Billing G557 in conjunction with C101 will trigger an automatic rejection, as the ICU/CCU premium is explicitly excluded from critical care per diem billing.
- Submitting G557 for a patient who is not in a designated critical care unit or for whom you are not the physician-in-charge is a frequent cause of audit recovery.
- Attempting to bill additional subsequent hospital visits (C002) on the same day as G557 is prohibited, as the per diem is intended to be all-inclusive.
Billing Tips
- Ensure your documentation clearly identifies the patient's location as a recognized ICU/CCU and specifies your role as the physician-in-charge to justify the per diem rate over standard visit codes.
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