OHIP Billing Codes for Geriatrics
Consultation
A075 Consultation
A070 Consultation in association with special visit to a hospital in-patient, long-term care in-patient or emergency department patient.
Claims submission instructions: Submit claim using A070 and the appropriate special visit premium beginning with "C" prefix for a hospital in-patient, “W” prefix for a long-term care in-patient or “K” prefix for an emergency department patient.
A775 Comprehensive Consultation
at least 65 years of age; or when the consultation is for the assessment of dementia; and where the physician spends at least 75 minutes with the patient exclusive of time spent rendering any other service to the patient
A770 Extended comprehensive geriatric consultation
at least 65 years of age; or when the consultation is for the assessment of dementia; and where the physician spends at least 90 minutes with the patient exclusive of time spent rendering any other service to the patient
A076 Repeat Consultation
A375 Limited Consultation
E082 MRP Premium – Add this to Admission consultation or admission assessment
*Please refer to the SoB pages GP16-19 and A99-100 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.
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.
Assessment / Follow-up – Automatic Codes (A07XA)
The MDBilling.ca automated codes allow a physician to bill a single code (A07XA) 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) are as follows:
Service | Limits | A07XA |
Medical Specific Assessment | Max of 1 per 12 months, or 2 if the second visit is an unrelated diagnosis | A073A |
Complex Medical Specific Re-Assessment | Max of 4 per 12 months, or any combination of A073 + A071 to a max of 4 per 12 months | A071A |
Medical Specific Re-Assessment | Max of 2 per 12 months | A074A |
Partial Assessment | Thereafter | A078A |
In-Patient Services
C075 Consultation
C755 Comprehensive geriatric consultation- subject to the same conditions as A775
C770 Extended comprehensive geriatric consultation- subject to the same conditions as A770
C375 Limited Consultation
C076 Repeat Consultation
C073 Medical Specific Assessment
C074 Medical Specific Re-Assessment
C071 Complex Medical Specific Re-Assessment
C777 Intermediate assessment - Pronouncement of death
C771 Certification of death - Note: Certification of death rendered in conjunction with A902 or A777/C777 is an insured service payable at nil.
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/E084A | C072A |
2nd Day | C123A + E083A/E084A | |
1 – 5th Week | C072A + E083A/E084A | |
6 - 13th Week | C077A + E083A/E084A | C077A |
13th + Week | C079A + E083A/E084A | C079A |
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
C078 Concurrent Care
C982 Palliative Care
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] |
Long Term Care In-Patient Services
W075 Consultation
W755 Comprehensive geriatric consultation- subject to the same conditions as A775
W770 Extended comprehensive geriatric consultation- subject to the same conditions as A770
W375 Limited Consultation
W076 Repeat Consultation
W272 Admission assessment - Type 1
W274 Admission assessment - Type 2
W277 Admission assessment - Type 3
W279 Periodic health visit
W074 General re-assessment of patient in nursing home*
*May only be claimed 6 months after Periodic health visit (as per the Nursing Homes Act)
W072 Subsequent visits - Chronic care or convalescent hospital - first 4 subsequent visits per patient per month … per visit
W071 Subsequent visits - Chronic care or convalescent hospital - additional subsequent visits (maximum 6 per patient per month) … per visit
W073 Subsequent visits - Nursing home or home for the aged - first 2 subsequent visits per patient per month … per visit
W078 Subsequent visits - Nursing home or home for the aged - subsequent visits per month (maximum 3 per patient per month) … per visit
W972 Subsequent visits - Nursing home or home for the aged - palliative care
W982 Subsequent visits - Chronic care or convalescent hospital - palliative care
W121 Additional visits due to intercurrent illness
W010 Monthly management fee (per patient per month)
*See General Preamble GP51 to GP53
Counselling & Interview
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
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