Fee item 00081 - Emergency Care
Fee item 00082 - Monitoring of Critically Ill Patients

Fee items 00081 and 00082 are billed in cases where a physician must provide constant bedside care to a critically ill patient. Each item is billable per half hour or major portion thereof when the criteria outlined in the MSC Payment Schedule are met (See General Services: Emergency Care). The following information will help you determine when to bill these items.

Fee item 00081 - Emergency Care

Fee item 00081 is appropriate for:

The evaluation, diagnosis and treatment of a critically ill patient who requires constant bedside care by a physician. A critically ill patient is defined as a patient with an immediately life-threatening illness/injury. For example:

  • Cardiac arrest
  • Multiple trauma
  • Acute respiratory failure
  • Coma
  • Shock
  • Cardiac arrhythmia with haemodynamic compromise
  • Hypothermia
  • Other immediately life-threatening conditions

Note: Fee item 00081 may be billed for use and monitoring by the physician of pharmacologic agents, such as inotropic or thrombolytic drugs for the above conditions.

Procedures included in fee item 00081:

The following procedures are included in 00081 and cannot be billed in addition to this fee item:

  • Defibrillation
  • Cardioversion
  • Peripheral intravenous lines
  • Arterial blood gases
  • Nasogastric tubes with or without lavage
  • Urinary catheters (as part of a cardiac arrest)

Procedures not included in fee item 00081:

Procedures not included in 00081 may be charged in addition when rendered to this fee item. The time spent rendering other non-included services should be provided and deducted from the time billed for 00081. Examples of such procedures are as follows:

  • Endotracheal intubation - as a separate entity, i.e., not part of a cardiac arrest or followed by an anaesthetic
  • Cricothyroidotomy
  • Venous cutdown
  • Arterial catheter
  • Diagnostic peritoneal lavage
  • Chest tube insertion
  • Pacemaker insertion

Fee Item 00081 is not appropriate for:

  • The intensive care sometimes necessary to prepare a patient for surgery unless active resuscitation is performed.
  • Constant attendance with a patient in labour.
  • Standby time such as waiting for laboratory results
  • Simple monitoring of the patient.
Tips: When a consultation is billed in addition to 00081, the consultation constitutes the first half hour of time spent with the patient (i.e. 00081 may not be billed for that first half hour).
Provide detailed information in your note record and/or correspondence regarding the patient's condition and the active treatment (e.g.: resuscitation) provided for time billed as fee item 00081. Details of services provided within each half hour are required.
Start and end times must be entered in both the billing claims and the patient's chart.

Fee item 00082 - Monitoring of Critically Ill Patients

Fee item 00082 is appropriate:

In cases where a critically ill patient requires continuous monitoring by a physician when modification of the care and active intervention is not required.

For example, if a patient requires continuous monitoring following resuscitation as the result of cardiac arrest, fee item 00081 may be billed for the time spent providing active resuscitation, and fee item 00082 may be billed for the time spent providing continuous monitoring.

When the patient's condition has stabilized and continuous monitoring is no longer required, follow-up care may be billed under the appropriate visit fees.

Note: Fee item 00082 is not applicable for monitoring during labour.

Tips: Start and end times must be entered in both the billing claims and the patient's chart.
Provide details of the requirement for continuous monitoring by the physician in your note record (e.g.: "constant monitoring required for one hour following resuscitation for cardiac arrest"). Details of services provided within each half hour are required.
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Disclaimer: MSP Tutor is intended to provide a guide for physicians and medical office assistants in billing claims to MSP. For definitive information on fee-for-service fee item codes and amounts, consult the current MSC Payment Schedule. If a discrepancy exists between the information contained in MSP Tutor and the MSC Payment Schedule, the information in the Payment Schedule will prevail.