[B]Resuscitation Codes: [/B]Bill [B]G521, G523[/B] and [B]G522[/B] for resuscitations such as VSA, Multiple Trauma, Coma, Cardio-respiratory failure, Shock from any cause, etc
[B]G521[/B] for first 15 minutes or part thereof
[B]G523[/B] for the second 15 minutes or part thereof
[B]G522[/B] for subsequent 15 minute periods or part thereof
Bill [B]G395[/B] and [B]G391[/B] for lesser resuscitation cases such as anaphylaxis, acute MI, major GI bleed, pulmonary edema, significant OD, etc - [B]G395 [/B]for first 15 minutes or part thereof - [B]G391 [/B]for subsequent 15 minute periods or part thereof[B]
Most important: As many as 4 of us can bill for the same case!! so help each other out in resus cases![/B]
It is suggested that whoever puts the billing codes on the chart, add the codes for other consultants who were in the room for part or all of the resuscitation, being sure to put their initials next to the codes.It is a judgement call as to whether or not the case merits a Critical Care Code (G521) or an Other Resuscitation code (G395). When these cases are severe, you may want to bill the G52x codes above.
These codes cover [B]most but not all [/B]invasive procedures. You may bill separate codes in addition to the critical care codes for chest tubes, thoracotomy, transvenous pacemakers (Greg!), pericardiocentesis, peritoneal lavage, and cardioversion.
Also note that it is general practice in the province to continue the time clock for these codes when speaking to family, either during or after the resuscitation.
And don’t forget to add a premium code if you perform the resuscitation on a weekend (H113), or at night (H112)
Jeff and I were talking about codes for precedural sedation. He came up with one, but I was understanding that we were not allowed to use it. Can you clarify?
Most of those K-Codes are counselling codes, and we cant use many of them. I have the relevant ones listed on the billing page of emergdoc.ca (see [URL=http://www.emergdoc.ca/content/view/25/43/#psych]here[/URL]).
But to re-iterate them:
K002 Interviews with relatives or a person who is authorized to make a treatment decision on behalf of the patient
[B]K003 [/B]Interviews with Children’s Aid Society (CAS) or legal guardian on behalf of the patient
[B]K004 [/B]Family Psychotherapy
[B]K005 [/B]Individual [I]Primary Mental Health Care[/I]
[B]K006 [/B]Individual [I]Hypnotherapy[/I]
[B]K007 [/B]Individual [I]Psychotherapy[/I]
[B]K013 [/B]Individual [I]Counselling[/I]
[B]K028 [/B]STD counselling (includes H&P and testing done).
Clearly some of those are no good (K004, K005, K006 and perhaps K007, although some might argue that we do some cognitive-behavioural psychotherapy in the dept.) The other ones simply stipulate that the interview must last 20 minutes. I use the [I]K013 [/I]and [I]K028 [/I]all the time.
The resusc codes are listed in the Oct 2006 schedule as billable by up to 3 docs for the G52x series and all subsequent docs can use the G391 code. I don’t see a max time limit, i.e., only 4 units billable for G522 and G391, but they only pay 27 and 21 $ respectively and we would likely not be going much beyond the first 2 or 3 units anyway.The R codes have traditionally had the visit codes (H codes) rejected and therefore I have used the H112 and 113 codes with the R codes when applicable. Reading the Surgical Preamble makes it a little confusing. They state that the non-Z procedure codes include the in hospital assessments, but they also state that the major preop assessment can be billed no matter the time elapsed between assessment and procedure. The latter implies that we should be able to bill a visit code with R codes but OHIP may not see it that way. Any comments?Billing for any local or procedural anesthesia is severely limited. The Schedule states that if you’re doing the procedure, you can’t bill for the anesthesia. The exception arises with the G224 code that allows additional billing for the blocks listed on our cards. If we were going to bill for sedation, we’d have to get a second colleague to do the sedation and bill separately using anesthetic codes. This is done using the sum of the basic units listed for the particular procedure plus the number of 15 minute blocks spent in attendance (time units) multiplied by the $12.01 fee per unit. For example a forearm reduction (fracture radius and ulna) has 5 basic units and if you spent 20 minutes in attendance you would add 2 time units for a total of 7 units or 7 x 12 = $84 for 20 minutes work. We would have to decide as a group if we want 2 docs involved with procedures that require sedation and then we’d have to compile a listing of basic unit values for all the procedures we do in the ED (actually not a huge number).
Hi Laura,The code for direct laryngoscopy with FB removal is Z322. The Z321 is for laryngoscopy with or without biopsy. I’ll send Mel and the group an email to allow correction of the cards.Cheers,Greg
Laura,Again, as with most of these K-codes, it is billed in “units” with 1 unit being “no less than 20 min”. The bottom line is that these patients require [I]some[/I] counselling, and thats what the code is there for.And not that this example means I am right, but I billed that code many times over in a walk-in situation (as do all the guys @ the STD clinic) and never had one rejected.A-