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OHIP Billing Codes for Hospitalist (GP): Cheat Sheet

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OHIP Billing Codes for Hospitalist (GP)

Consultations & Assessments

 

Out-patient

In-patient

Consultation

A005

C005

Special family and general practice consultation (min. of 50 mins of direct contact with patient)

A911

C911

Repeat consultation

A006

C006

On-call admission assessment

A933

C933

General assessment

A003

C003

General re-assessment

A004

C004

 

E082   MRP Premium – Add this to admission consultation or assessment

 

Other Assessments 

A007   Intermediate assessment or well baby care

A001   Minor Assessment

 

Special Visit Premiums (Emergency Department)

*When billing with 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 with 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
C960
(max. 2 per
time period)

$36.40
C961
(max. 2 per
time period)

$36.40
C962
(max. 2 per
time period)

$36.40 

C963 (max. 6 per time period)

$36.40
C964
(no max. per
time period)

First Person Seen

$20.00
C990
(max. 10
(total of first
and additional
person seen)
per time
period)

$40.00
C992
(max. 10
(total of first
and additional
person seen)
per time
period)

$60.00
C994
(max. 10
(total of first
and additional
person seen)
per time
period)

$75.00
C986
(max. 20
(total of first
and additional
person seen)
per time
period)

$100.00
C996
(no max. per
time period)

Additional Person(s) seen

$20.00
C991
(max. 10
(total of first
and additional
person seen)
per time
period)

$40.00
C993
(max. 10
(total of first
and additional
person seen)
per time
period)

$60.00
C995
(max. 10
(total of first
and additional
person seen)
per time
period)

$75.00
C987
(max. 20
(total of first
and additional
person seen)
per time
period)

$100.00
C997
(no max. per
time period)

 * 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 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) for you.

 

IPTXA (Non-MRP - covering): Our system will choose the correct inpatient subsequent visit code for you.

 

Day / Week after admission

IPTMA

IPTXA

1st Day

C122A + E083A

C002A

2nd Day 

C123A + E083A

1 – 5th Week

C002A + E083A

6 - 13th Week

C007A + E083A

C007A

13th + Week

C009A + E083A

C009A

 

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 Visit 

C121   Additional visit due to intercurrent illness

C008   Concurrent Care

C010   Supportive Care

C882   Palliative Care

G512   Palliative Case Care Management (limit of one per week)

C777   Intermediate assessment - Pronouncement of death

 

Counselling & Interview

K002   Interview with relatives

K013   Individual counselling

K015   Counselling of relatives - on behalf of catastrophically or terminally ill patient

Note: 

  1. Per unit fee calculated in ½ hour increment, minimum of 20 minutes

# 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]

 

  1. 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.

 

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]

 

Forms

K070   Home Care Application

K038   Completion of Long-Term Care health report form

 

Home care supervision

K071   Acute home care supervision (first 8 weeks following admission to home care program)

K072   Chronic home care supervision (after the 8th week following admission to the home care program)

 

MDBilling.ca Learning Video

Learn Hospitalist Billing in Under 13 minutes

 

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