Out-Patient Consultation & Assessments
A015 Consultation
A215 Limited Consultation
A016 Repeat Consultation
A013 Specific Assessment
A014 Partial Assessment
*Please refer to the SoB page GP 17-19 for the detailed Consultation payment rules.
Special Visit Premiums (Emergency Department)
*When billing 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.
In Patient Consultation & Assessments
C015 Consultation
C215 Limited Consultation
C016 Repeat Consultation
C013 Specific Assessment
C014 Specific Re-Assessment
Special Visit Premiums (In-Patient)
*When billing 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/E084) for you.
IPTXA (Non-MRP - covering): Our system will choose the correct inpatient subsequent visit code for you.
MRP Subsequent Visit Premium
E083 Weekday
E084 Saturday, Sunday or Holiday
Day / Week after admission | IPTMA (MRP Rounding) | IPTXA (Non-MRP – covering) |
1st Day | C122A + E083A | C012A |
2nd Day | C123A + E083A | |
1 – 5th Week | C012A + E083A | |
6 - 13th Week | C017A + E083A | C017A |
13th + Week | C019A + E083A | C019A |
Other Subsequent Visits by MRP
C142 Day following transfer – add E083.
C143 Day 2 following transfer – add E083. MRP prior to ICU visit and MRP post must be different specialties.
C124 Day of discharge – add E083 if the patient in hospital for at least 48 hours.
Other Visits
C018 Concurrent Care (allowed 4 the first week then 2 every week after).
C982 Palliative Care – add E083 if MRP.
C121 Intercurrent illness – diagnosis must be totally different than admission diagnosis.
Anaesthetic Fee Codes
Anesthetic procedure codes have a “C” suffix. E.g.
Total quantity = Time units + Basic Units (1 Unit fee = $15.01)
Total fee = Total quantity x Anesthesiologist unit fee
MDBilling.ca system has a time-saving feature to calculate the time unit / unit fees. Please refer to OHIP Billing Tip #33 - Time Units, Surgical/Anesthesia
Cancelled Surgery – Anaesthesia Services
IPTXA/IPTMA Bill subsequent visit if patient has been examined, but the surgery is cancelled prior to induction of anesthesia
E006C If the surgery is called after the anaesthetic has begun, 6 basic units
Second Anaesthesiologist
E001C When the anaesthetic services of more than one anaesthesiologist are necessary
Anaesthesia Premiums
After Hours Premiums
E400C Evening Premium
17:00 – 24:00 Monday to Friday or daytime and evenings on Saturdays, Sundays or Holidays
Adds 50% to the total anaesthetic fee
E401C Night Premium
00:00 – 07:00
Adds 75% to the total anaesthetic fee
Special Visit Premiums
*Only eligible for payment when an anaesthesiologist is required to travel to make a special visit to the hospital to administer an anaesthetic
C998C Evening Premium
17:00 – 24:00; or for non-elective surgery with sacrifice of office hours during Monday to Friday
Maximum of 2 per shift
C985C Saturdays, Sundays or Holidays daytime and evenings
07:00 – 24:00
Maximum of 6 per shift
C999C Night Premium
00:00 – 07:00
Unlimited
Anaesthesia Extra Units
Fee code | Criteria | Numbers of extra units |
E021C | premature newborn less than 37 weeks gestational age | 9 units |
E014C | newborn to 28 days | 5 units |
E009C | infant from 29 days to 1 year of age | 4 units |
E019C | infant or child from 1 year to 8 years of age inclusive | 2 units |
E007C | adult aged from 70 to 79 years, inclusive | 1 unit |
E018C | adult aged 80 years and older | 3 units |
E010C | patient with body mass index (BMI) > 40 | 2 units |
E011C | patient in prone position during surgery | 4 units |
E024C | patient in sitting position during surgery, greater than 60 degrees upright | 4 units |
E025C | unanticipated massive transfusion – transfusion of at least one blood volume of red blood cells | 10 units |
E012C | patient who is known to have malignant hyperthermia or there is a strong suspicion of susceptibility, and the anaesthetic requires full malignant hyperthermia set up and management | 5 units |
E022C | ASA III - patient with severe systemic disease limiting activity but not incapacitating | 2 units |
E017C | ASA IV – patient with incapacitating systemic disease that is a constant threat to life | 10 units |
E016C | ASA V – moribund patient not expected to live 24 hours with or without operation | 20 units |
E020C | ASA E - patient undergoing anaesthesia for emergency surgery which commences within 24 hours of operating room booking, to E022C, E017C, or E016C | 4 units |
Notes:
Units are fixed. No time unit will be added
Age premiums are automatically calculated and paid
E016C, E017C, E020C are not eligible for payment when anesthesia is rendered to a brain dead patient for organ donations**
Anaesthesia for Nerve Block Procedures
E030C Procedural sedation, 4 basic units
E031C General anaesthesia or deep sedation, 4 basic units
**E030C and E031C are not payable with the above list of “Extra Units.”
Replacement of Listed Basic Units
Fee code | Description | Replace Number of Basic units with |
E650C | when a pump (with or without an oxygenator and with or without hypothermia) is used in conjunction with an anaesthetic | 28 units |
E645C | off pump coronary artery bypass grafting, to R742 or R743 | 40 units |
E002C | when hypothermia is used by the anaesthesiologist in procedures not specifically identified as requiring hypothermia | 25 units |
E013C | when anaesthetic management is required for the emergency relief of acute upper airway (above the carina) obstruction (excluding choanal atresia) | 10 units |
Z432C is not payable for an anesthesia service in support of a nerve block.