G601 – Neonatal intensive care - 2nd day onwards
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Level A Neonatal Intensive Care is a per diem service for the second day onwards, rendered by a physician for being in constant or periodic attendance to provide all aspects of care to Intensive Care Area patients. Level A Definition Full life support including monitoring (either invasive or non-invasive), ventilatory support and parenteral alimentation (all modalities). Included Services The service consists of an initial consultation or assessment and such subsequent assessments as may be indicated, including ongoing monitoring of the patient's condition and the following procedures as required: - insertion of arterial, venous, C.V.P. or urinary catheters - intravenous lines - interpreting of blood gases - nasogastric intubation with or without anaesthesia - pressure infusion sets and pharmaceutical agents - endotracheal intubation - tracheal toilet - artificial ventilation and all necessary measures for respiratory support. Separately billable interventions may be claimed in addition to this fee. **Note from :** 1. Physician-in-charge is the physician(s) daily providing the Neonatal Intensive Care. 2. These are team fees which apply to neonatologists/paediatricians/anaesthetists providing complete care. If an infant has been transferred from one level of care to another, in either direction, up or down, the second day benefits (e.g., G601, G611, G621) apply.
When to Use
- Use G601 for the second day onwards when a neonate requires full life support, including invasive monitoring and mechanical ventilation.
- Use G601 when a patient is transferred from a different level of care (e.g., from Level B G611 to Level A) to signify the start of the new level of care on the second day of that specific intensity.
- Use G601 for ongoing daily management of a neonate in a Level A intensive care unit where the physician is providing comprehensive, all-inclusive care.
Common Pitfalls
- Billing G601 on the same day as G600, G603, or G604 will result in a rejection as these are mutually exclusive first-day codes.
- Attempting to bill C101 (ICU/CCU premium) alongside G601 is a common error, as G601 is a comprehensive team fee that already accounts for intensive care services.
- Billing C142 or C143 for a patient who is already under your care in the NICU is prohibited, as these codes are intended for transfers out of the intensive care area.
Billing Tips
- Ensure the patient's clinical documentation explicitly supports 'Level A' criteria, such as active mechanical ventilation and parenteral alimentation, to withstand audit scrutiny.
- Remember that G601 is an all-inclusive per diem; do not unbundle procedures like endotracheal intubation or catheter insertions, as these are already included in the fee.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
ManagementFee
Diagnostic and Therapeutic Procedures
Applies to newborn and infant patients in neonatal intensive care.
Physician-in-charge is the physician(s) daily providing the Neonatal Intensive Care.
These are team fees which apply to neonatologists/paediatricians/anaesthetists providing complete care. If infant has been transferred from one level to another in either direction, up or down, second day benefits apply.
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