OHIP Billing Codes for Medical Oncology

A445 Consultation

A446 Repeat Consultation

A845 Limited Consultation

A765 Consultation patient 16 years and under

E082 MRP Premium – Add this to Admission consultation/assessment if you are MRP

*Please refer to the SoB page GP 16-19 for the detailed Consultation payment rules.

*When billing Special Visit Premiums, use A-prefix consultation or assessment.

Not eligible for payment to Emergency Department Physicians (see definition GP67)

* Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.

The MDBilling.ca automatic codes allow physicians to bill a single code (A44XA) for a “follow up”, and our software will automatically choose the highest paying assessment based on existing assessment codes previously billed in our database. The algorithm will choose the highest paying assessment code first, and subsequently bill assessment codes in decreasing fee value per the rules from the OHIP Schedule of Benefits (section GP23-25).

The rules for the automatic re/assessment services (in-patient and virtual) are as follows:
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C445 Consultation

C765 Consultation, patient 16 years of age and under

C845 Limited Consultation

C446 Repeat Consultation

C443 Medical Specific Assessment

C444 Medical Specific Re-Assessment

C441 Complex Medical Specific Re-Assessment

C777 Intermediate assessment - Pronouncement of death

C771 Certification of death

*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).

* Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.

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 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 Holidays

C142 + E083/E084 1st day following transfer from ICU

C143 + E083/E084 Second day following transfer from ICU

C124 + E083/E084 Day of discharge (patient must be in hospital for at least 48 hours).

Other Visits

C121 Additional visit due to intercurrent illness

C448 Concurrent Care

C982 Palliative Care

Automatic Codes (K01XA / K04XA)

When billing counselling codes, there are limits on the number of units billable before the need to select a different service code (refer to OHIP Schedule of Benefits section A19).

HOW TO USE:

Simply bill K01XA (Individual Counselling) or K04XA (Group Counselling), and the system will search for existing counselling codes in our database and choose the appropriate counselling code for you.

Note:

Note: 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 Benefits page GP29 for further information.

K005 Primary mental health care

K014 Counselling for transplant recipients, donors or families of recipients and donors

K015 Counselling of relatives - on behalf of catastrophically or terminally ill patient

K002 Interview with relatives

K121 Hospital in-patient case conference

Unit calculation chart:

G388 Management of special oral chemotherapy, for malignant disease

G382 Supervision of chemotherapy (pharmacologic therapy of malignancy or autoimmune disease) by telephone, monthly

G345 Complex single agent or multi-agent therapy – chemotherapy and/or biologic agent(s) that can cause vesicant damage, infusion reactions, cardiac, neurologic, marrow or renal toxicities that may require immediate intervention by the physician

G381 Standard chemotherapy - agents with minor toxicity that require physician monitoring

G281 each additional standard chemotherapy agent(additional to G381), other than the initial agent

G359 Special single agent or multi-agent therapy – chemotherapy and/or biologic agent(s) with major toxicity that require frequent monitoring and prolonged administration periods and may require immediate intervention by the physician

* Please refer to the SoB page J58-J60 for the detailed Chemo payment rules.

E078 Chronic disease assessment premium is payable in addition to the amount payable for an assessment when all of the criteria are met.

Note: E078 is ONLY eligible for payment with outpatient (i.e., A-prefix) assessments when billed under a diagnosis from the below chart:

* Please refer to the SoB page GP26-GP26 for the detailed E078 payment rules.