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G791
G791 – Acquired acute brain injury management - 2nd to 30th day
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G791 is a per diem management fee payable for the care of a patient with an acquired acute brain injury. It is applicable from the 2nd day to the 30th day, inclusive, of the same hospital admission. This service is not payable for stabilized patients, regardless of whether they are in an ICU. It is also not payable on the same day as other services including consultations, assessments, critical care fees, or time-based services like counselling.
When to Use
- Use G791 for daily management of a patient with an acute brain injury who remains unstable and requires active neurological monitoring between the 2nd and 30th day of admission.
- Select G791 when the patient is in a non-ICU setting but still requires intensive management that precludes the use of standard daily assessment codes like A007.
Common Pitfalls
- Billing G791 on the same day as a consultation or subsequent visit code will result in an automatic rejection due to the exclusivity rules.
- Continuing to bill G791 after the patient has reached a stabilized state is a frequent audit trigger, as the code specifically excludes stabilized patients.
- Attempting to claim G791 alongside critical care per diem fees for the same patient on the same day will lead to a billing conflict.
Billing Tips
- Ensure your documentation clearly reflects the ongoing instability of the brain injury to justify the use of G791 over standard daily assessment codes.
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