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Automatic OHIP Codes

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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.

 

RE/ASSESSMENTS (A[][]XA) – "Patient Review" or "Follow Ups"

 

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).

The rules for the automatic re/assessment codes are as follows (replace [][] with your 2 digit specialty):

  • Medical Specific Assessment:
    A[][]3 max of 1 per 12 months, or 2 if the second visit is an unrelated diagnosis.
  • Complex Medical Specific Re-Assessment:
    A[][]1 max of 4 per 12 months, or any combination of A[][]3+A[][]1 to a max of 4 per 12 months
  • Medical Specific Re-Assessment:
    A[][]4 max of 2 per 12 months
  • Partial Assessment:
    A[][]8 thereafter

 

HOW TO USE:

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:

  • Internal Medicine (13), the automatic code for Re/Assessment is: A13XA
  • Cardiology (60), the automatic code for Re/Assessment is: A60XA
  • Medical Oncology (44), the automatic code for Re/Assessment is: A44XA
  • Hematology (61), the automatic code for Re/Assessment is: A61XA
  • Respirology (47), the automatic code for Re/Assessment is: A47XA

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)

 

automatic_OHIP_Code.png

This automation code is available for the following disciplines:

  • Cardiology (60)
  • Clinical Immunology (62)
  • Community Medicine (05)
  • Endocrinology & Metabolism (15)
  • Gastroenterology (41)
  • Geriatrics (07)
  • Haematology (61)
  • Infectious Disease (46)
  • Internal And Occupational Medicine (13)
  • Medical Oncology (44)
  • Nephrology (16)
  • Neurology (18)
  • Physical Medicine & Rehabilitation (31)
  • Radiation Oncology (34)
  • Respiratory Disease (47)
  • Rheumatology (48)
 

INPATIENT VISITS (IPTMA, IPTXA) – "Rounding"

 

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 (day after admission)
C123A + E083A (2nd day after admission)
C[][]2A + E083A (1st 5 weeks after admission)
C[][]7A + E083A (6 - 13th week after admission)
C[][]9A + E083A (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)

 

HOW TO USE:

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

  • Anaesthesia (01)
  • Cardiac Surgery (09)
  • Cardiology (60)
  • Clinical Immunology (62)
  • Community Medicine (05)
  • Dermatology (02)
  • Endocrinology & Metabolism (15)
  • Family Practice & Practice In General (00)
  • Gastroenterology (41)
  • General Surgery (03)
  • General Thoracic Surgery (64)
  • Genetics (22)
  • Geriatrics (07)
  • Haematology (61)
  • Infectious Disease (46)
  • Internal And Occupational Medicine (13)
  • Medical Oncology (44)
  • Nephrology (16)
  • Neurology (18)
  • Neurosurgery (04)
  • Obstetrics And Gynaecology (20)
  • Ophthalmology (23)
  • Orthopaedic Surgery (06)
  • Otolaryngology (24)
  • Physical Medicine & Rehabilitation (31)
  • Plastic Surgery (08)
  • Psychiatry (19)
  • Radiation Oncology (34)
  • Respiratory Disease (47)
  • Rheumatology (48)
  • Urology (35)
  • Vascular Surgery (17)
 

COUNSELLING (Patient: K01XA, Group: K04XA)

 

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:

  • Patient 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 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.

 

PALLIATIVE CARE (G51XA)

 

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:

  • To the last G512 found in the system
  • To the full consult found
  • To the last 6 months

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:

  • Haematology (61)
  • Internal And Occupational Medicine (13)
  • Medical Oncology (44)
 

HOW TO USE:

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.

 

Specific to Oncology Practices

CHEMOTHERAPY TELEPHONE SUPVERSION (G38XA)

 

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:

  • To the last G382 found in the system
  • To the Full Consult found
  • To the last 6 months

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).

 

HOW TO USE:

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.

 

ANTICOAGULANT SUPERVISION – TELEPHONE ADVICE (G27XA)

 

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

 

MANAGEMENT OF ORAL CHEMO + TELPHONE SUPERVISION (G38YA)

 

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:

  • Rule 1: G388 is only eligible for payment once every twenty-one (21) days.
  • Rule 2: G388 is only eligible of six (6) services per patient per 12 month period.
  • Rule 3: G388 is not eligible when G382 is billed on the same month.

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

 

HOW TO USE:

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.

 

HOME CARE SUPERVISION (K07XA)

 

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

  • K071 - Acute home care supervision (first 8 weeks following admission to the program)
  • K072 - Chronic home care supervision (after the 8th week following admission to 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:

  • Admission Date = K070 date + 1

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

  • The K07XA will resolve to K071A if the (Service Date – Admission Date) =< 56 days
  • The K07XA will resolve to K072A if the (Service Date – Admission Date) > 56 days

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

 

HOW TO USE:

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.

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