G522

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 271 / A143

CONSULTATIONS AND VISITS
 NEUROLOGY (18)
          Payment rules:
          1.A384 and K181 are only eligible for payment for patients seen within the timeframe for
            eligibility for intravenous thrombolysis therapy as defined by the Canadian Stroke Best
            Practices.
          2.A384 and K181 must be rendered in a hospital with CT or MRI facilities onsite.
          3.A384 and K181 are only eligible for payment to a specialist in Neurology (18).
          4.A384 and K181 are only eligible for payment if the physician remains in constant attendance
            with the patient.
          5.G521, G522, G523, or G391 are not eligible for payment with A384 or K181.
          6.K181 is only eligible for payment for patients treated with intravenous thrombolysis therapy
            as defined by the Canadian Stroke Best Practices.
          7.K181 is limited to a maximum of 6 units per patient per day.
          [Commentary:
          The Canadian Stroke Best Practices can be found at the following link: https://
          www.strokebestpractices.ca/recommendations/acute-stroke-management/acute-ischemic-
          stroke-treatment ]

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 440 / J26

LIFE THREATENING CRITICAL CARE
      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.
      [Commentary:
      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.]
    Amount payable per physician per patient for the first three physicians:
 G521 - first ¼ hour (or part thereof) ...............................................         125.10
 G523 - second ¼ hour (or part thereof)..........................................               64.50
 G522 - after first ½ hour, per ¼ hour (or part thereof) ....................                   42.50
 G391 Amount payable per physician per patient for the fourth and
        subsequent physicians (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 "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.

PDF page 441 / J27

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
 CRITICAL CARE
                                                                                              Fee
          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.
          5. G521, G522, G523, or G391 are not eligible for payment with A384 or K181.
          Medical record requirements:
          The service is eligible for payment only if start and stop times of the service are recorded in the
          patient's permanent medical record.
          [Commentary:
          Time unit total may include time which is consecutive or non-consecutive.]

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.

PDF page 533 / K3

OBSTETRICS
 PREAMBLE
  10. The listings for “Attendance at labour and delivery” and for “Attendance of obstetric
      consultant(s) at delivery” may not be claimed by any physician when a patient is transferred to a
      second physician for normal obstetrical care.
    11. Ordinary immediate care of the newborn is included in the labour-delivery fee and when the
        service is rendered by the anaesthesiologist, it is included in the anaesthetic benefit. A life
        threatening emergency situation requiring active resuscitation of the newborn provided by any
        physician may be claimed under codes G521, G522, G523. When indicated, endotracheal
        intubation and tracheo-bronchial toilet should be billed under G211 and not as G521, G522,
        G523.
    12. When an obstetrician routinely transfers all newborns to another physician, the latter may not
        claim a consultation for these transferals. If the baby is well, the physician should claim newborn
        care in hospital plus attendance at maternal delivery (H007/H267) if this service is provided. If
        the baby is sick, the physician may claim a general assessment and attendance at maternal
        delivery (H007/H267) if this service is provided plus daily visits for as long as his/her services
        are required.
    13. If an obstetrician who normally cares for newborns him/herself or transfers the care of newborns
        to a family physician, refers a newborn to a paediatrician because of the complexity, obscurity or
        seriousness of the case, the latter may claim for this service according to the following
        guidelines:
        a. If attendance at maternal delivery is provided, C263 may be claimed in addition to H267 if a
           general assessment of the baby is carried out. A postnatal consultation of the baby, (C265)
           may not be claimed in addition to attendance at maternal delivery (H267).
        b. If attendance at maternal delivery (H267) is not provided, a postnatal consultation (C265)
           may be claimed, if rendered, whether or not a prenatal consultation has already been
           claimed.
    14. Physicians may claim for assisted breech delivery under fee code P020 when the service
        includes spontaneous delivery to the umbilicus, with extraction of the shoulders, arms and
        head.
    15. See General Preamble GP103 for After Hours Premiums.
    16. If claims are being submitted in coded form, the obstetrician should add the suffix “A” to the
        listed procedural code, the assistant should add the suffix “B” to the listed procedural code, and
        the anaesthesiologist should add the suffix “C” to the listed procedural code.

Master, record 2233. Record Layout PDF, page 1.

G52220260401999999990000042500000000000000000000000000000000000000000000000

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.