OHIP Billing Codes for Hematology
Consultation
A615 Consultation
A616 Repeat Consultation
A655 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.
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.
Assessment / Follow-up – Automatic Codes (A61XA)
The MDBilling.ca automatic codes allow physicians to bill a single code (A61XA) 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).
Service | Limits | A61XA (In-person) |
Medical Specific Assessment | Max of 1 per 12 months, or 2 if the second visit is an unrelated diagnosis | A613A |
Complex Medical Specific Re-Assessment | Max of 4 per 12 months, or any combination of A613 + A611 to a max of 4 per 12 months | A611A |
Medical Specific Re-Assessment | Max of 2 per 12 months | A614A |
Partial Assessment | Thereafter | A618A |
In-Patient Services
C615 Consultation
C765 Consultation, patient 16 years of age and under
C655 Limited Consultation
C616 Repeat Consultation
C613 Medical Specific Assessment
C614 Medical Specific Re-Assessment
C611 Complex Medical Specific Re-Assessment
C777 Intermediate assessment - Pronouncement of death
C771 Certification of death
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 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
Day / Week after admission | IPTMA (MRP Rounding) | IPTXA (Non-MRP – covering) |
1st Day | C122A + E083A/E084A | C612A |
2nd Day | C123A + E083A/E084A |
|
1 – 5th Week | C612A + E083A/E084A |
|
6 - 13th Week | C617A + E083A/E084A | C617A |
13th + Week | C619A + E083A/E084A | C619A |
Other Subsequent Visits by MRP
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
C618 Concurrent Care
C982 Palliative Care
Counselling & Interviews
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).
Individual Counselling (K01XA): K013 for the first three units of K013 and K040 combined per patient per provider per 12 month period; K033 thereafter.
Group Counselling (K04XA): K040 for the first three units of K013 and K040 combined per patient per provider per 12 month period; K041 thereafter.
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:
Per unit fee calculated in ½ hour increment
# 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 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
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
Hospital in-patient case conference
K121 Hospital in-patient case conference
Unit calculation chart:
# 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] |
E078- Chronic Disease Assessment Premium
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 GP25-GP26 for the detailed E078 payment rules.
Diagnostic Code | Description |
42 | AIDS |
43 | AIDS-related complex |
44 | Other human immunodeficiency virus infection |
250 | Diabetes mellitus, including complications |
286 | Coagulation defects (e.g. haemophilia, other factor deficiencies) |
287 | Purpura, thrombocytopenia, other haemorrhagic conditions |
290 | Senile dementia, presenile dementia |
299 | Child psychoses or autism |
313 | Behavioural disorders of childhood and adolescence |
315 | Specified delays in development (e.g. dyslexia, dyslalia, motor retardation) |
332 | Parkinson's Disease |
340 | Multiple Sclerosis |
343 | Cerebral Palsy |
345 | Epilepsy |
402 | Hypertensive Heart Disease |
428 | Congestive Heart Failure |
491 | Chronic Bronchitis |
492 | Emphysema |
493 | Asthma, Allergic Bronchitis |
515 | Pulmonary Fibrosis |
555 | Regional Enteritis, Crohn's Disease |
556 | Ulcerative Colitis |
571 | Cirrhosis of the Liver |
585 | Chronic Renal Failure, Uremia |
710 | Disseminated Lupus Erythaematosus, Generalized Scleroderma, Dermatomyositis |
714 | Rheumatoid Arthritis, Still's Disease |
720 | Ankylosing Spondylitis |
721 | Other seronegative spondyloarthropathies |
758 | Chromosomal Anomalies |
765 | Prematurity, low-birthweight infant |
902 | Educational problems |