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OHIP Billing Codes for Internal Medicine: Cheat Sheet

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OHIP Billing Codes for Internal Medicine 

Consultation

A135   Consultation

A136   Repeat Consultation

A435   Limited Consultation

A130   Comprehensive Consultation (min. of 75 mins direct contact with patient)

A765   Consultation patient 16 years and under

E082   MRP Premium – Add this to Admission consultation or admission assessment

*Please refer to the SoB page GP 17-19 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.

 

Assessment / Follow-up – Automatic Codes (A13XA/A13VA)

The MDBilling.ca automated codes allow a physician to bill a single code (A13XA/ A13VA) 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 and virtual) are as follows:
(Note: A13VA includes the 12% Internal Medicine Assessment Premiums for physicians who are practicing solely as a general internist.)

 

Service

Limits

A13XA    (In-person)

A13VA (Virtual)

Medical Specific Assessment

Max of 1 per 12 months, or 2 if the second visit is an unrelated diagnosis

A133A

K083A x 18

Complex Medical Specific Re-Assessment

Max of 4 per 12 months, or any combination of A133 + A131 to a max of 4 per 12 months

A131A

K083A x 16

Medical Specific Re-Assessment

Max of 2 per 12 months

A134A

K083A x 14

Partial Assessment

Thereafter

A138A

K083A x 9

 

In-Patient Services 

C135   Consultation

C765   Consultation, patient 16 years of age and under

C130   Comprehensive Internal Medicine Consultation – minimum time spent 75 mins

C435   Limited Consultation

C136   Repeat Consultation

C133   Medical Specific Assessment

C134   Medical Specific Re-Assessment

C131   Complex Medical Specific Re-Assessment

C777   Intermediate assessment - Pronouncement of death

C771   Certification of death

 

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
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/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

C132A

2nd Day 

C123A + E083A/E084A

1 – 5th Week

C132A + E083A/E084A

6 - 13th Week

C137A + E083A/E084A

C137A

13th + Week

C139A + E083A/E084A

C139A


Other Subsequent Visit 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 Visit 

C121   Additional visit due to intercurrent illness

C138   Concurrent Care

C982   Palliative Care

 

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: 

  1. 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]

 

  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.

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

 

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]

 

MDBilling.ca Billing Resource

Learning Video: Learn Internal Medicine Billing in Under 11 Minutes

To know more about how to bill virtual services, please refer to Virtual Care Billing Guide during COVID-19

 

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