G604 – Neonatal low birth weight intensive care
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Neonatal Intensive Care is the service rendered by a physician for being in constant or periodic attendance during a one-day period, to provide all aspects of care to Intensive Care Area patients. This 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 these fees. G604 is a team fee for neonatal low birth weight intensive care, payable in lieu of G600 or G603 for a newborn less than 750 grams in weight or 26 weeks gestational age. It applies to neonatologists, paediatricians, and/or anaesthetists providing complete care.
When to Use
- Use G604 exclusively for neonates weighing less than 750 grams or at 26 weeks gestational age or less, replacing the standard G600 or G603 codes.
- Apply this code when providing comprehensive daily intensive care, including intubation, catheter insertion, and blood gas interpretation, as these are bundled into the daily fee.
Common Pitfalls
- Billing G604 alongside G600 or G603 will result in an automatic rejection as G604 is specifically designated as the replacement code for these weight and age criteria.
- Failing to account for the 'second day benefits' rule when an infant is transferred between levels of care often leads to incorrect claims and subsequent audit adjustments.
Billing Tips
- Ensure the patient's birth weight or gestational age is clearly documented in the chart to support the use of G604 over G603 during Ministry audits.
- Remember that while G604 includes most intensive care procedures, you may still claim separately billable interventions if they fall outside the comprehensive list defined in the Schedule of Benefits.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Procedure
Diagnostic and Therapeutic Procedures
Newborn patient, from birth up to and including 28 days of age.
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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