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OHIP Billing Codes for Anaesthesia: Cheat Sheet

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OHIP Billing Codes for Anaesthesia

Out-Patient Consultation & Assessments

A015   Consultation

A215   Limited Consultation

A016   Repeat Consultation

A013   Specific Assessment

A014   Partial 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.

 

In Patient Consultation & Assessments

C015   Consultation

C215   Limited Consultation

C016   Repeat Consultation

C013   Specific Assessment

C014   Specific Re-Assessment

 

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

C012A

2nd Day 

C123A + E083A

1 – 5th Week

C012A + E083A

6 - 13th Week

C017A + E083A

C017A

13th + Week

C019A + E083A

C019A

 

Other Subsequent Visits by MRP

C142   Day following transfer – add E083.

C143   Day 2 following transfer – add E083. MRP prior to ICU visit and MRP post must be different specialties.

C124   Day of discharge – add E083 if the patient in hospital for at least 48 hours.

 

Other Visits 

C018   Concurrent Care (allowed 4 the first week then 2 every week after).

C982   Palliative Care – add E083 if MRP.

C121   Intercurrent illness – diagnosis must be totally different than admission diagnosis.

 

Anaesthetic Fee Codes

Anesthetic procedure codes have a “C” suffix. E.g. 

Total quantity = Time units + Basic Units (1 Unit fee = $15.01)   

Total fee = Total quantity x Anesthesiologist unit fee

MDBilling.ca system has a time-saving feature to calculate the time unit / unit fees. Please refer to OHIP Billing Tip #33 - Time Units, Surgical/Anesthesia

 

Cancelled Surgery – Anaesthesia Services

IPTXA/IPTMA   Bill subsequent visit if patient has been examined, but the surgery is cancelled prior to induction of anesthesia

E006C   If the surgery is called after the anaesthetic has begun, 6 basic units

 

Second Anaesthesiologist

E001C   When the anaesthetic services of more than one anaesthesiologist are necessary

 

Anaesthesia Premiums

After Hours Premiums

E400C   Evening Premium

  • 17:00 – 24:00 Monday to Friday or daytime and evenings on Saturdays, Sundays or Holidays
  • Adds 50% to the total anaesthetic fee 

E401C   Night Premium

  • 00:00 – 07:00 
  • Adds 75% to the total anaesthetic fee 

 

Special Visit Premiums

*Only eligible for payment when an anaesthesiologist is required to travel to make a special visit to the hospital to administer an anaesthetic

C998C   Evening Premium

  • 17:00 – 24:00; or for non-elective surgery with sacrifice of office hours during Monday to Friday
  • Maximum of 2 per shift

C985C   Saturdays, Sundays or Holidays daytime and evenings

  • 07:00 – 24:00
  • Maximum of 6 per shift

C999C   Night Premium

    • 00:00 – 07:00 
  • Unlimited

 

Anaesthesia Extra Units

Fee 

code

Criteria

Numbers of extra units

E021C

premature newborn less than 37 weeks gestational age

9 units

E014C

newborn to 28 days

5 units

E009C

infant from 29 days to 1 year of age

4 units

E019C

infant or child from 1 year to 8 years of age inclusive

2 units

E007C

adult aged from 70 to 79 years, inclusive

1 unit

E018C

adult aged 80 years and older

3 units

E010C

patient with body mass index (BMI) > 40

2 units

E011C

patient in prone position during surgery

4 units

E024C

patient in sitting position during surgery, greater than 60 degrees upright

4 units

E025C

unanticipated massive transfusion – transfusion of at least one blood volume of red blood cells

10 units

E012C

patient who is known to have malignant hyperthermia or there is a strong suspicion of susceptibility, and the anaesthetic requires full malignant hyperthermia set up and management

5 units

E022C

ASA III - patient with severe systemic disease limiting activity but not incapacitating

2 units

E017C

ASA IV – patient with incapacitating systemic disease that is a constant threat to life

10 units

E016C

ASA V – moribund patient not expected to live 24 hours with or without operation

20 units

E020C

ASA E - patient undergoing anaesthesia for emergency surgery which commences within 24 hours of operating room booking, to E022C, E017C 

or E016C

4 units

 

Notes:

      • Units are fixed. No time unit will be added
      • Age premiums are automatically calculated and paid
  • E016C, E017C, E020C are not eligible for payment when anesthesia is rendered to a brain dead patient for organ donations**

 

Anaesthesia for Nerve Block Procedures

E030C   Procedural sedation, 4 basic units

E031C   General anaesthesia or deep sedation, 4 basic units

**E030C and E031C are not payable with the above list of “Extra Units.

 

Replacement of Listed Basic Units

Fee

code

Description

Replace Number of Basic units with

E650C

when a pump (with or without an oxygenator and with or without hypothermia) is used in conjunction with an anaesthetic

28 units

E645C

off pump coronary artery bypass grafting, to R742 or R743

40 units

E002C

when hypothermia is used by the anaesthesiologist in procedures not specifically identified as requiring hypothermia

25 units

E013C

when anaesthetic management is required for the emergency relief of acute upper airway (above the carina) obstruction (excluding choanal atresia)

10 units

 

Z432C is not payable for an anesthesia service in support of a nerve block.

 

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