Automatic OHIP Codes

By using MDBilling.ca’s software automation you can save time, improve accuracy, and ultimately, maximize your monthly revenue.

Important: please familiarize yourself with the Schedule of Benefits, and how the automatic OHIP codes work. If you are not sure, do not use the automatic codes.

The MDBilling.ca automation allows for a physician to bill a single code for a “follow up”, and our software will automatically choose the highest paying assessment based on existing codes previously billed in our database. The algorithm will choose the highest paying re/assessment code first, and subsequently bill assessment codes in decreasing fee value, taking into account that each re/assessment code has a limit of the number of times it can be billed per every 12 months, as per the rules from the OHIP Schedule of Benefits (section GP14-16).

This automatic code is available for the following disciplines:

Simply use the automatic code: A[][]XA (replace [][] with your 2 digit specialty), and our system will maximize your follow-up billings for you.

As an example:

You no longer have to determine which re/assessment code to bill. Just bill A[][]XA and we will automatically choose the correct code for you.

Please note the automation code only works for “A” prefix codes, but not with “C” prefix codes.

You can find your two digit specialty under:
PREFERENCES - MY DETAILS - Specialty (see screenshot below)

IMPORTANT NOTE:

When billing A[][]XA with Chronic Disease Assessment Premium (E078A), please take the following steps:

Related: Use E[][]VA to bill virtual assessments with Chronic Disease Assessment Premium (E078A). Please see Automatic Code E[][]VA - K083 for Follow-Up/Assessments + E078 for more details.

When rounding on patients, the service codes will differ depending on the number of days the patient has been admitted. The MDBilling.ca automation allows for a physician to bill one code for rounding, and for our software system to automatically choose the correct (and highest paying) code allowed based on the admission date entered.

The algorithm will choose the codes as follows ([][] represents your 2 digit specialty discipline):
IPTMA
C122A + E083A/E084A (day after admission)
C123A + E083A/E084A (2nd day after admission)
C[][]2A + E083A/E084A (1st 5 weeks after admission)
C[][]7A + E083A/E084A (6 - 13th week after admission)
C[][]9A + E083A/E084A (13th+ week after admission)
​
IPTXA
C[][]2A (1st 5 weeks after admission)
C[][]7A (6 - 13th week after admission)
C[][]9A (13th+ week after admission)

Rounding MRP - simply use the automatic code: IPTMA and our system will choose the correct inpatient visit code and add the MRP premium (E083/E084) for you.

Non-MRP (covering) - simply use the automatic code: IPTXA and our system will choose the correct inpatient visit code for you.

The automation code is available for the following disciplines:

When billing counselling codes, there are limits on the number of units that you can bill before the need to select a different service code.

The limits are defined in the OHIP Schedule of Benefits section A15 as follows:

Simply use the codes K01XA (patient counselling) or K04XA (group counselling), and we will search for existing counselling codes in our database, and our system will choose the appropriate counselling code for you.

The palliative care case management code G512 can be billed once per week if you are the MRP. Billing G512 can be tedious. We have created a “back billing” code that will automatically bill once per week in the following priority:

The algorithm assumes you have been providing continuous care for the patient, and that you started the management of the patient either when you first billed the G512 or the full consult. If neither are found in the system, we will bill to the last 6 months (the maximum allowed timeframe before OHIP considers the claim stale dated).

This automation code is available for the following disciplines:

Simply use the code G51XA and our system will automatically bill G512A once per week as per the above algorithm.

Be careful using this code if you did not provide continuous care (ie/ you were not the MRP at all times) as somebody else is likely billing this code. Whoever bills the palliative care code first will get paid.

The chemotherapy telephone supervision code G382 can be billed once per month if you are the MRP. Billing G382 can be tedious. We have created a “back billing” code that will automatically bill once per month in the following priority:

The algorithm assumes you have been providing continuous care for the patient, and that you started the management of the patient either when you first billed the G382 or the full consult. If neither are found in the system, we will bill to the last 6 months (the maximum allowed timeframe before OHIP considers the claim stale dated).

Simply use the code G38XA and our system will automatically bill G382A once per month as per the above algorithm.

Be careful using this code if you did not provide continuous care (ie/ you were not the MRP at all times) as somebody else is likely billing this code. Whoever bills the monthly telephone supervision code first will get paid.

Similar to G38XA, you can use the code G27XA to backbill the Anticoagulant Supervision code G271A.

We have created an automatic code to optimize the billing of management of oral chemo (G388) and telephone supervision (G382).

G388 has the following payment rules:

The automation code will bill a G388 if the above rules are met. Otherwise, the G382 (lower paying) code will be billed.

Simply use the code G38YA on the date(s) the patient is being treated with special oral chemo. There is no need to track when and how many times you have billed G388A. Our system will automatically optimize between billing G388A and G382. Please note that unlike G51XA and G38XA, G38YA will not be automatically back billed.

We have created an automatic code to optimize the billing of acute (K071) and chronic (K072) home care supervision. The rules for billing home care supervision depends on when the patient was admitted to the program

Based on the feedback from physicians, we have adopted the admission date to be approximately "one day after" after the application to the program:

The automation code will optimize the home care supervision billing as follows:

If no admission date is found (ie/ no K070A has been billed), then K072A will be billed.

Simply use the code K07XA and our system will automatically optimize between billing K071A and K072A. There is no need to track the admission date to the program.