Penny (MDBilling.ca Support)OHIP Billing Codes for OBSTETRICS AND GYNAECOLOGY
General Listing
A205 Consultation*
A935 Special surgical consultation (50 minute minimum, refer to SoB page GP19)
A206 Repeat consultation*
A203 Specific assessment*
A204 Partial Assessment
Non-Emergency Hospital In-Patient Services
C205 Consultation*
C935 Special surgical consultation (50 minute minimum, refer to SoB page GP19)
C206 Repeat consultation*
C203 Specific assessment*
C204 Specific re-assessment*
*The Papanicolaou smear is included in the consultation, repeat consultation, general or specific assessment (or re-assessment), or routine post-natal visit when pelvic examination is normal part of the foregoing services. However, the add-on codes E430 or E431 can be billed in addition to these services when a papanicolaou smear is performed outside hospital.
E082 MRP Premium – Add this to Admission consultation/assessment if you are MRP, per SoB page GP42:
- E082 is not eligible for payment for a patient admitted for obstetrical delivery or for a newborn
- E082 is not applicable for any consultation or assessment related to day surgery
Please refer to the SoB pages GP16-19 and A127 for the detailed Consultation payment rules.
Special Visit Premiums (Emergency Department)
For emergency calls and other special visits to inpatients use General Listings and Premiums when applicable.
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) |
Special Visit Premiums (Out-Patient)
Hospital Out-Patient Department
|
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 U963 (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 |
Special Visit Premiums (In-Patient)
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 |
* When billing Special Visit Premiums, use A-prefix consultation or assessment. Please refer to the SoB page GP 65-68 for the detailed Special Visit Premium payment rules.
Prenatal Care
P003 General assessment (major prenatal visit)
P005 Antenatal preventative health assessment
P004 Minor prenatal assessment
Labour - Delivery
P006 Vaginal
P020 Operative delivery, i.e. mid-cavity extraction or assisted breech delivery
E502 - vaginal birth after caesarean section (VBAC) whether successful or unsuccessful
P018 Caesarean section
P041 Caesarean section including tubal interruption
P042 Caesarean section including hysterectomy
P009 Attendance at labour and delivery
C989 Special visit for first obstetrical delivery with sacrifice of office hours
E411 Sole delivery premium - Payable in addition to labour and delivery fees P006A, P009A, E414, P018A, P020A, P038A or P041A if sole delivery in calendar day, to maximum of 25 sole delivery premiums per physician per fiscal year.
P007 Postnatal care in hospital and/or home
P008 Postnatal care in office
High Risk Pregnancies
P030 Cervical ripening using topical, oral or mechanical agents, maximum once per pregnancy. Payable in conjunction with P023
P023 Oxytocin infusion for induction or augmentation of labour
P025 Non stress test
Newborn Care
H001 Newborn care in hospital and/or home
H002 Low birth weight baby care (uncomplicated) - initial visit
H003 Low birth weight baby care (uncomplicated) - subsequent visit per visit
After hours procedure premiums
Physician – other than an Emergency Department Physician (refer to GP104)
E409 Evenings (17:00h – 24:00h) Monday to Friday or daytime and evenings on Saturdays, Sundays, Holidays
E410 Nights (00:00h – 07:00h)
Diagnostic And Therapeutic Procedures
G334 Telephone supervisory fee for ovulation induction with human menopausal gonadotropins or gonadotropin-releasing hormone (not eligible for payment same day as visit), to a maximum of 10 per cycle (per call)
G489 Venipuncture - adolescent or adult
Chemotherapy
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
Laboratory Medicine In Physician’s Office
Reproductive medicine (refer to J66)
G015 FSH (pituitary gonadotrophins)
G016 TSH (thyroid stimulating hormone)
G017 Prolactin
G018 Estradiol
G019 LH (luteinizing hormone)
G020 Progesterone
G021 HCG (human chorionic gonadotrophins) quantitative
Reproductive medicine (refer to J69)
G009 Urinalysis, routine (includes microscopic examination of centrifuged specimen plus any of SG, pH, protein, sugar, haemoglobin, ketones, urobilinogen, bilirubin)
G010 One or more parts of above without microscopy
Female Genital Surgical Procedures - Cervix Uteri
ENDOSCOPY (refer to V8)
Z731 Initial investigation of abnormal cytology of vulva and/or vagina or cervix under colposcopic technique with or without biopsy(ies) and/or endocervical curetting
Z787 Follow-up colposcopy with biopsy(ies) with or without endocervical curetting
Z730 Follow up colposcopy without biopsy with or without endocervical curetting
Note: 1. A screening colposcopy is included in the assessment. 2. Z720 is not eligible for payment with Z730, Z731 or Z787.
Assessment / Follow-up – Automatic Codes (A20XA)
The MDBilling.ca automated codes allow a physician to bill a single code (A20XA) 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 | A20XA (In-person) |
| Specific Assessment | Max. of 1 per 12 months, or 2 if the second visit is an unrelated diagnosis | A203A |
| Partial Assessment | Thereafter | A204A |
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.
See General Preamble GP44 to GP45 for terms and conditions.
C122, C123 are not eligible for payment:
b. for a patient admitted for obstetrical delivery or newborn care; or
c. for any visit rendered by a surgeon during the 2 days prior to non-Z prefix surgery
HOW TO USE:
IPTMA (MRP Rounding): Our system will choose the correct inpatient subsequent visit code and add the MRP premium (E083) for you.
IPTXA (Non-MRP - covering): Our system will choose the correct inpatient subsequent visit code for you.
| Day / Week after admission | IPTMA (MRP Rounding) | IPTXA (Non-MRP – covering) |
| 1st Day | C122A + E083A | C202A |
| 2nd Day | C123A + E083A | |
| 1 – 5th Week | C202A + E083A | |
| 6 - 13th Week | C207A + E083A | C207A |
| 13th + Week | C209A + E083A | C209A |
Other Subsequent Visit by MRP
C142 + E083 1st day following transfer from ICU
C143 + E083 Second day following transfer from ICU
C124 + E083 Day of discharge (patient must be in hospital for at least 48 hours).
Other Visits
C121 Additional visit due to intercurrent illness
C208 Concurrent Care
C982 Palliative Care
C777 Intermediate assessment - Pronouncement of death
C771 Certification of death
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
- With the exception of the codes listed in the 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 Benefit 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
MDBilling.ca Billing Resource
To know more about how to bill virtual services, please refer to Virtual Care Billing Guide during COVID-19