G611 – Neonatal intensive care - Level B - 2nd day onwards
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
Neonatal Intensive Care is a team fee service rendered by a physician (neonatologist, paediatrician, or anaesthetist) for being in constant or periodic attendance during a one-day period, to provide all aspects of care to Intensive Care Area patients. This service includes an initial consultation or assessment and subsequent assessments, ongoing monitoring, and various procedures as required. G611 specifically covers Level B care from the second day onwards. Level B is defined as intensive care including monitoring (invasive or non-invasive), oxygen administration, and intravenous therapy, but without ventilatory support. Included Procedures (as per ): - 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.
When to Use
- Use G611 for a neonate requiring ongoing intensive monitoring and IV therapy on day two or later, specifically when the patient does not require mechanical ventilation.
- Use G611 when a patient is downgraded from a higher-level care code like G601 or G603 to a lower-intensity management level on the second day or later.
- Use G611 when a patient is upgraded from a lower-level care code like G610 to a higher-intensity management level on the second day or later.
Common Pitfalls
- Billing G611 alongside C101 is a common rejection, as G611 is a comprehensive team fee that already accounts for intensive care attendance.
- Attempting to bill G611 concurrently with other neonatal intensive care codes (e.g., G600, G601, G610) for the same patient on the same day will result in a rejection.
- Failing to recognize that G611 is strictly for the second day onwards; billing it for the initial day of admission will trigger an audit or rejection.
Billing Tips
- Since G611 is a comprehensive team fee, ensure you do not bill for individual procedures listed in the J34 section that are already bundled into the daily management fee.
- If a patient's clinical status changes, ensure the transition to G611 is clearly documented to support the 'second day benefits' rule when moving between different levels of care.
Effective: April 1, 2025
J. Diagnostic and Therapeutic Procedures
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
ManagementFee
Diagnostic and Therapeutic Procedures
Applies to newborns and infants requiring 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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