Consultations & Assessments
| Out-patient | In-patient |
Consultation | A005 | C005 |
Special family and general practice consultation (min. of 50 mins of direct contact with patient) | A911 | C911 |
Repeat consultation | A006 | C006 |
On-call admission assessment | A933 | C933 |
General assessment | A003 | C003 |
General re-assessment | A004 | C004 |
E082 MRP Premium – Add this to admission consultation or assessment
Other Assessments
A007 Intermediate assessment or well baby care
A001 Minor Assessment
Special Visit Premiums (Emergency Department)
*When billing with Special Visit Premiums, use A-prefix consultation or assessment.
Not eligible for payment to Emergency Department Physicians (see definition GP67)
Premium | Weekdays Daytime (07:00- 17:00) | Weekdays Daytime (07:00 - 17:00) with Sacrifice of Office Hours | Evenings (17:00- 24:00) Monday through Friday | Sat., Sun. and Holidays (07:00- 24:00) | Nights (00:00- 07:00) |
Travel Premium | $36.40
K960 (max. 2 per time period) | $36.40
K961 (max. 2 per time period) | $36.40
K962 (max. 2 per time period) | $36.40
K963 (max. 6 per time period) | $36.40
K964 (no max. per time period) |
First Person Seen | $20.00
K990 (max. 10 (total of first and additional person seen) per time period) | $40.00
K992 (max. 10 (total of first and additional person seen) per time period) | $60.00
K994 (max. 10 (total of first and additional person seen) per time period) | $75.00
K998 (max. 20 (total of first and additional person seen) per time period) | $100.00
K996 (no max. per time period) |
Additional Person(s) seen | $20.00
K991 (max. 10 (total of first and additional person seen) per time period) | $40.00
K993 (max. 10 (total of first and additional person seen) per time period) | $60.00
K995 (max. 10 (total of first and additional person seen) per time period) | $75.00
K999 (max. 20 (total of first and additional person seen) per time period) | $100.00
K997 (no max. per time period) |
* Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.
Special Visit Premiums (In-Patient)
*When billing with Special Visit Premiums, use A-prefix consultation or assessment.
The “C” prefix consult codes are strictly for non-emergency inpatient consults (and therefore no special visits apply).
Premium | Weekdays Daytime (07:00- 17:00) | Weekdays Daytime (07:00 - 17:00) with Sacrifice of Office Hours | Evenings (17:00- 24:00) Monday through Friday | Sat., Sun. and Holidays (07:00- 24:00) | Nights (00:00- 07:00) |
Travel Premium | $36.40 | $36.40 | $36.40 | $36.40
C963 (max. 6 per time period) | $36.40 |
First Person Seen | $20.00 | $40.00 | $60.00 | $75.00 | $100.00 |
Additional Person(s) seen | $20.00 | $40.00 | $60.00 | $75.00 | $100.00 |
* Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.
Hospital Rounding – Automatic Codes (IPTMA, IPTXA)
Service codes for rounding will differ depending on the number of days the patient has been admitted. The MDBilling.ca automatic codes allow a physician to enter one code for rounding. Our software system will automatically choose the correct (and highest paying) inpatient subsequent visit service allowed based on the admission date entered.
HOW TO USE:
IPTMA (MRP Rounding): Our system will choose the correct inpatient subsequent visit code and add the MRP premium (E083) for you.
IPTXA (Non-MRP - covering): Our system will choose the correct inpatient subsequent visit code for you.
Day / Week after admission | IPTMA | IPTXA |
1st Day | C122A + E083A | C002A |
2nd Day | C123A + E083A |
|
1 – 5th Week | C002A + E083A |
|
6 - 13th Week | C007A + E083A | C007A |
13th + Week | C009A + E083A | C009A |
Other Subsequent Visit by MRP
C142 + E083 1st day following transfer from ICU
C143 + E083 Second day following transfer from ICU
C124 + E083 Day of discharge (patient must be in hospital for at least 48 hours).
Other Visit
C121 Additional visit due to intercurrent illness
C008 Concurrent Care
C010 Supportive Care
C882 Palliative Care
G512 Palliative Case Care Management (limit of one per week)
C777 Intermediate assessment - Pronouncement of death
Counselling & Interview
K002 Interview with relatives
K013 Individual counselling
K015 Counselling of relatives - on behalf of catastrophically or terminally ill patient
Note:
Per unit fee calculated in ½ hour increment, minimum of 20 minutes
# Units | Minimum time |
1 unit: | 20 minutes |
2 units: | 46 minutes |
3 units: | 76 minutes [1h 16m] |
4 units: | 106 minutes [1h 46m] |
5 units: | 136 minutes [2h 16m] |
6 units: | 166 minutes [2h 46m] |
7 units: | 196 minutes [3h 16m] |
8 units: | 226 minutes [3h 46m] |
With the exception of the codes listed in the below, no other services are eligible for payment when rendered by the same physician the same day as any type of counselling service: E080, G010, G039, G040, G041, G042, G043, G202, G205, G365, G372, G384, G385, G394, G462, G480, G489, G482, G538, G590, G840, G841, G842, G843, G844, G845, G846, G847, G848, H313, K002, K003, K008, K014, K015, K031, K035, K036, K038, K682, K683, K684, K730
Detention (K001) time may be payable following a consultation or assessment when a physician is required to spend considerable extra time in treatment or monitoring of the patient. See OHIP Schedule of Benefit page GP29 for further information.
Hospital in-patient case conference
K121 Hospital in-patient case conference
Unit calculation chart:
# Units | Minimum time |
1 unit | 10 minutes |
2 units | 16 minutes |
3 units | 26 minutes |
4 units | 36 minutes |
5 units | 46 minutes |
6 units | 56 minutes |
7 units | 66 minutes [1h 6m] |
8 units | 76 minutes [1h 16m] |
Forms
K070 Home Care Application
K038 Completion of Long-Term Care health report form
Home care supervision
K071 Acute home care supervision (first 8 weeks following admission to home care program)
K072 Chronic home care supervision (after the 8th week following admission to the home care program)