G395

PDF page 123 / GP109

Definition/Required elements of service:
The trauma premium is payable for each of the services and units described below when:
         a. rendered either on the day of the trauma or within 24 hours of the trauma; and
         b. for trauma patients age 16 or more who have an Injury Severity Score (ISS) of greater than
            15, or for patients less than age 16 who have an Injury Severity Score of greater than 12.
   E420 Trauma premium ...................................................... add 50%
Payment rules:
    1. The premium is applicable to the following services and units;
         a. services listed in the Consultation and Visits Section (Section A of the Schedule);
         b. services listed in the Obstetrics Section (Section K of the Schedule);
         c. services listed in the Surgical Procedures section (Section M through Z of the Schedule);
         d. the following resuscitative services: G395, G391, G521, G522 and G523.
         e. basic and time units provided by surgical assistants; or
         f. basic and time units provided by anaesthesiologists.
    2. The premium is payable only for the services for which the medical record lists the ISS score.

PDF page 426 / J12

Arrhythmia induction
     To include programmed electrical stimulation, drug provocation and termination of arrhythmia, if
     necessary - once per patient per 24 hours.
# G261 - atrial.................................................................................... 331.05
# G259 - ventricular...........................................................................     383.30
       Note:
       G261and/or G259 are not eligible for payment with G521, G522, G523, G395 and G391.

PDF page 427 / J13

Electrophysiologic pacing, mapping and ablation
# G178 - catheter ablation therapy....................................................            352.05
# G179 - repeat pacing, mapping and catheter ablation for additional
          distinct arrhythmia(s) without the use of an advanced
          mapping system .................................................................        111.20
          Note:
          G179 is not eligible for payment with Z423.
# Z424         - transseptal left heart catheterization, with or without
                 pressure measurements, with or without dye injection.......                      297.15    6
          Note:
          1.Z424 is only eligible for payment when rendered with G176, G177 and/or G178.
          2.Z424 is eligible for payment for each transseptal catheter placement to a maximum of 2.
# Z422         - retrograde aortic left heart catheterization with or without
                 pressure measurement(s) ..................................................       210.55    6
          Note:
          1.Z422 is only eligible for payment when rendered with G176, G177 and/or G178.
          2.Z422 is limited to a maximum of one per electrophysiological pacing, mapping and/or
            ablation sitting.
   G115 External cardiac pacing (temporary transthoracic) once per 24-
          hour period .........................................................................    46.30
      Note:
      G115 is not eligible for payment with G521, G522, G523, G395 and G391.
# G366 Testing of arrhythmia inducibility by acute administration of
         anti-arrhythmic or adrenergic drugs to a maximum of 2 per
         24 hours .............................................................................   148.50
          Note:
          G366 is not eligible for payment for the use of isoproterenol for arrhythmia induction when
          rendered with G261 and/or G259.
# Z443 Insertion of temporary endocardial electrode .........................                     154.10    6
# Z431 Repositioning of temporary endocardial electrode .................                          64.25    6
    Endomyocardial Biopsy
# G288 - transvascular, right or left ...................................................         200.00
    Tilt table testing of vasomotor syncope
# G314 - to include arterial cannulation, provocative and blocking
           drugs, physician must be continually present.....................                      112.00

PDF page 442 / J28

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
CRITICAL CARE
                                                                                           Fee
   OTHER CRITICAL CARE
    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".
    Amount payable per physician per patient for the first three physicians:
 G395 - first ¼ hour (or part thereof) ............................................... 64.70
 G391 - after first ¼ hour per ¼ hour (or part thereof).....................           34.35
    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.

PDF page 442 / J28

Payment rules:
     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.

Master, record 2106. Record Layout PDF, page 1.

G39520260401999999990000064700000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.