Critical care diagnostic & therapeutic procedures G395 - Amount payable per physician per patient for the first three physicians: - first ¼ hour (or part thereof)

General Info

Billing Amount: $56.80

Description

The service rendered when a physician provides resuscitation assessment and procedures in an emergency in circumstances other than those described as "life threatening critical care", where there is a potential threat to life or limb of such a type that without resuscitation efforts by the physician, there is a high probability the patient will suffer loss of limb or require "life threatening critical care".

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 "other 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.

1. G395 is not eligible for payment with G521, G522 or G523 for services rendered to the same patient by the same physician on the same day.
2. 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 "other 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 units may include time which is consecutive or non-consecutive.
3. During the time reported for which any of these codes is claimed, the physician cannot provide services to other patients.
4. "Other 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.
5. Consultation or assessments rendered before or after provision of "other 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.

Life threatening critical care and other critical care
The duration of "life threatening critical care" and "other critical care" services that physicians should document is the time they actually spend evaluating, managing, and providing care to the critically ill or injured patient to the exclusion of all other work.
For example, time spent reviewing laboratory test results or discussing the critically ill patient's care with other medical staff in the unit or at the nursing station on the floor would be included in the definition of critical care, even when it does not occur at the bedside, if this time represents their full attention to the management of the critically ill/injured patient.
Time spent involved in activities in any location other than the bedside, emergency department or hospital floor where the patient is located cannot be claimed as the physician is not immediately available to the patient.
Submit claims manually when the total time spent in providing "life threatening critical care" or "other critical care" is greater than two (2) hours.