Critical care diagnostic & therapeutic procedures G521 - Amount payable per physician per patient for the first three physicians: - first ¼ hour (or part thereof)

General Info

Billing Amount: $110.55

Description

The service rendered when a physician provides critical care to a critically ill or critically injured patient. For the purpose of this service, a critical illness or critical injury is one that acutely impairs one or more vital organ system(s) causing vital organ system failure as a result of which imminent life threatening deterioration in the patient's condition is highly probable.

Notes:

The following services are not eligible for payment when rendered to the same patient by the same physician on the same day as any code described as "life threatening critical care":
1. Assessment and ongoing monitoring of the patient's condition.
2. Intravenous lines.
3. Cutdowns.
4. Arterial and/or venous catheters.
5. Central venous pressure (CVP) lines.
6. Endotracheal intubation.
7. Tracheal toilet.
8. Blood gases.
9. Nasogastric intubation with/without anaesthesia with/without lavage.
10. Urinary catheters.
11. Pressure infusion sets and pharmacological agents.
12. Defibrillation.
13. Cardioversion.

Examples of vital organ system failure include but are not limited to: central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic and or respiratory failure.

1. The time unit is measured as the physician time spent fully devoted to the care of the patient and excludes time spent on separately billable interventions on the patient receiving the "life threatening critical care". The service is only eligible for payment for services rendered by the physician at the bedside or in the emergency department or on the hospital floor where the patient is located. Time unit total may include time which is consecutive or non-consecutive.
2. During the time reported for which any of these codes is claimed, the physician cannot provide services to other patients.
3. "Life threatening critical care" is not eligible for payment for the services of a physician rendered to the same patient on the same day for which the physician is paid a per diem fee for Critical Care (intensive care area), Ventilatory Support, Comprehensive Care or Neonatal Intensive Care.
4. Consultation or assessments rendered before or after provision of "life threatening critical care" may be eligible for payment on a fee-for-service basis but not when claiming Critical Care (intensive care area), Ventilatory Support, Comprehensive Care or Neonatal Intensive Care per diem fees.

The service is eligible for payment only if start and stop times of the service are recorded in the patient's permanent medical record.

Time unit total may include time which is consecutive or non-consecutive.