October 25, 2014

Emergency OHIP Fee Codes

   

Assessments

Weekday (0800-1700)   Weekday Evening (1700-2400)
H101 Minor 14.70   H131 Minor 16.15
H102 Comprehensive 36.45   H132 Comprehensive 40.10
H103 Multi-System 29.65   H133 Multi-System 32.65
H104 Re-assessment 14.70   H134 Re-assessment 16.15
 
Weekday Evening 1700-2400   Weekend/Holiday 0800-2400
H131 Minor 16.15   H151 Minor 22.05
H132 Comprehensive 40.10   H152 Comprehensive 54.70
H133 Multi-System 32.65   H153 Multi-System 44.50
H134 Re-assessment 16.15   H154 Re-assessment 22.05
 
Night (0000-0800)   Premiums (use wkend/night with G or K codes)
H121 Minor 25.75   H112 Nights: 0000-0800 (not with H codes) 14.70
H122 Comprehensive 63.80   H113 Day/Eve: 0800-2400 (not with H codes) 8.65
H123 Multi-System 51.90  
H124 Re-assessment 25.75  
 
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Critical Care   Critical Care
G521 Life threatenting:1st 15 mins 82.25   G395 Other resus: 1st 15 mins 42.25
G523 2nd 15 mins 41.10   G391 Each 15 mins after (max 2) 21.10
G522 Each 15 mins after (max 4) 27.05  
 
 
Special Visits (A & K Codes)   Special Visits (A & K Codes)
Emergency Physician (EP)on duty or on call for pre-arranged period/shift:   EP not on duty – not in conjunction with pre-arranged designated period of time on duty
07-1800h max 2 separate special visits   A & K for first pt seen, all subsequent pts billed as H
18-2400h max 3 separate special visits    
00-0700h all separate special visits   Non EP on call/who is detained b/c of high volume
all subsequent pts billed with H codes   A & K for first 10 pts seen, all subsequent pts billed as H
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Premiums   Assessments
K990 0700-1700 1st pt 18.20   A001 Minor assessment 17.75
K991 0700-1700 subsequent (max) pts 10.35   A007 Intermediate assessment 30.20
K994 1700-2400 1st pt 54.55   A003 General assessment 58.20
K995 1700-2400 subsequent (max) pts 27.30   A777 Pronouncement & Certification of death 30.20
K996 0000-0700 1st pt 81.85   A771 Certification of death 17.75
K997 0000-0700 subsequent (max) pts 40.95  
 
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Admissions   Consultations
H105 EP admits to other MRP (inpt interim adm) 18.10   H055 FRCP consultation 84.40
C004 EP admits to other MRP at their request 30.70   H065 All other EM consultations 56.25
C933 EP admits and is the MRP 79.20  
  Detention in Ambulance
Special Visit-Surg Proc (incl frac/disloc not H or G)   K101 Ground Ambulance (per 15 mins) 42.10
E409 Eve/Wkd procedures 18-2400h (see GP 60) +50%   K111 Air ambulance (per 15 mins) 126.40
E410 Night procedures 24-0800h (see GP 60) +75%   K112 Return w/out pt to place of original (pr/30mins) 25.05
  K001 Non ambulance (per 15 mins) 21.10
 
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Counselling/Mental Health   Cardiovascular
K014 Counselling/donor (per ½ hr) 51.70   Z437 Cardioversion 66.00
K013 Counselling/education (per ½ hr) 51.70   Z443 Transverse Pacemaker 154.10
K004 Counselling/family–2 or more members in attendance 56.10   Z401 Pericardiocentesis 131.70
K015 Counselling relatives re terminally ill (per ½ hr) 51.70  
K623 Form 1 Mental Health Assessment 85.65   Respiratory Surg Proc
K007 Psychotherapy (30 mins) 51.70   Z331 Thoracentesis (dx) 25.15
H313 Rehabilitation counselling 51.70   Z332 Thoracentesis (tx) 45.85
K028 STD ½ hr (includes H&P, tests, etc) 51.70  
(Counselling not to be billed in conjunction with other consults/visits)  
 
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OB/GYN  
P009 Non OBGYN attending L&D/CS resus newborn 395.75  
G365 Pap smear 6.75  
 
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Eyes/ENT   Eyes/ENT
Z847 Chalazion-excision 26.60   Z312 FB nose, complicated 50.90
Z315 Epistaxis – anterior pack unilateral 15.35   Z324 FB larynx 35.50
Z316 Epistaxis–Ant & Post Pack (uni or bilateral) 35.50   Z324 Laryngoscopy (indirect) 35.50
Z314 Epistaxis–Cautery Unilateral 11.50   Z321 Laryngoscopy (direct w removal of FB) 61.30
E108 Eye enucleation 131.25   Z322 Laryngoscopy FB removal (direct) 106.45
Z854 eye lid abscess I&D 40.90   G420 Syringe/curetting ears (uni or bilat) 11.25
Z915 FB ear, simple 10.55   G435 Tonometry 5.10
Z847 FB eye (1) 26.60   S023 Tooth extraction (1) 24.90
Z848 FB eye (2) 38.00   E700 Tooth extraction (each additn'l) 13.40
Z845 FB eye (3 or more) ???   Z326 Tracheostomy tube change 11.25
Z311 FB nose, simple 10.55   G403 Particle Repositioning Manoeuver 21.15
 
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GU/GI   GU/GI
Z543 Anoscopy 6.25  
Z595 Drainage cath replace in abdomen 43.60   G355 NG Tube–Diagnostic 9.60
Z756 Fecal disempaction 36.80   G356 NG Tube–Therapeutic 33.80
Z611 Foley catheter 8.55   G476 Prostatic massage 5.40
Z520 Gastrostomy tube change 8.60   Z535a Sigmoidoscopy 36.80
 
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IV-Venipuncture   IV-Venipuncture
Z459 Arterial puncture–ABG's 9.10   G379 IV adult 6.15
G268 Arterial line 31.25   G376 IV infant/child 10.20
Z269 Central line 31.25   G380 IV cutdown 27.05
Z341 Chest tube 62.85   Z804 Lumbar puncture 41.00
Z341 Drainage/effusion/pneumothorax 62.85   Z590 Paracentesis/abd (diagnostic) 25.25
G355 Gastric lavage (diagnostic) 9.60   Z591 Paracentesis/abd (therapeutic) 46.50
G356 Gastric lavage (therapeutic) 33.80   Z763 Peritoneal lavage 38.70
G372 IM, SC injection 2.32   K061 Police Blood Demand 30.00
G370 Injection/aspiration bursa/joint/ganglion (1) 19.90   G489 Venipuncture-adult 2.32
G371 Injection/aspiration bursa/joint/ganglion (>1) 10.00   G482 Venipuncture-child 6.25
G270 Intraosseous line 23.90   G480 Venipuncture-infant 9.25
 
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Minor Surgery/Subcutaneous   Minor Surgery/Subcutaneous
R606 Amputate phalanx hand 161.45   Z101 I&D abscess/hematoma (1) 20.10
R660 Burn: debride & excise (d&e): per hand/each digit 28.90   Z173 I&D abscess/hematoma (2) 30.35
R661 Burn: d&e: dorsum palm-each 47.95   Z545 I&D hemorrhoid 25.25
R662 Burn: d&e: face/scalp/neck each 28.90   Z106 I&D ischiorectal/pilonidal 44.35
R637 Burn: d&e: per % body, not hand,head,neck 29.65   Z104 I&D perianal abscess 20.10
Z341 Chest tube 62.50   Z211 Intubation (ET) 28.80
Z122 Cyst removal face/neck – one 32.70   R525 Muscle repair (complex) ltr to MOH, I.C. 0.00
Z123 Cyst removal face/neck – two 47.60   Z128 Nail ingrown (simple/wedge) 23.80
Z124 Cyst removal face/neck->3 65.35   Z129 Nail ingrown (multiple) 35.70
Z153 Debride & dress burns – major (unable to bill Z176) 14.05   Z130 Nail removal radical 62.75
E656 Extensive debridement 288.85   Z401 Pericardiocentesis 131.70
R578 Ext. tendon repair 164.40   R150 Plastic repair, very minor 92.30
R585 Flexor tendon 307.60   R151 Plastic repair, minor 140.25
Z114 Foreign body removal skin 18.80   Z783 Secondary closure 97.35
R517 foreign body muscle 107.70   Z162 Skin lesion, excise/suture (1) 14.80
Z520 Gastrostomy-tube change 8.60   Z163 Skin lesion excise/suture (2) 22.15
  Z164 Skin lesion excise/suture (>3) 36.90
 
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Suturing   Nerve Blocks(not paid if used as anesth for J40-43)
E199 Eyelid repair laceration–Full thick (note: an optho should really do this. Why are you doing this?) 131.25   G224 Block allowed in addition to procedure for: pudendal, femoral, intercostal, sciatic, ilioinguinal, ulnar, median, radial, brachial 15.55
Z176 Laceration under 5cm (@50% for glue/steristrips) 14.80   G125 Epidural for pain relief 45.75
Z154 Laceration under 5cm, face/bleeder/layers 35.90   G225 Mental branch of mandibular nerve 34.20
Z175 Laceration 5.1-10cm 35.90   G250 Maxillary or mandibular division of trigeminal nerve 75.10
Z177 Laceration 5.1-10cm, face/bleeder/layers 71.30   G218 Ilioinguinal and iliohypogastric nerve 54.65
Z179 Laceration 10.1-15cm 50.40   G219 Infraorbital 34.20
Z190 Laceration 10.1-15cm face/bleeder/layers 101.45   G220 Intercostal nerve 34.20
Z187 Complex face repair (must take 20 minutes or more)     G221 Intercostal nerve – each additional one 16.95
Z188 Complex repair elsewhere except finger zone 1 repairs (must take 20 minutes or more)     G258 Intrapleural block (single injection) 44.25
Z189 Complex finger zone 1 repairs (must take 20 minutes or more)  
Z783 Secondary closure 97.35
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ORTHO

Casts/Splints   Casts/Splints
Z204 Cast removal 10.25   Z213 Leg below knee/cast splint 24.10
Z202 Hand cast/splint 14.90   Z213 Full leg cast/splint 24.10
Z201 Finger cast/splint 10.25   Z208 Shoulder spica 97.35
Z199 Foot cast/splint 14.90   Z198 Toes/cast splint 10.25
Z203 Forearm cast/splint 24.10   Z216 Wedging of casts in other than # tx 10.25
(not billed if fracture code used)  
 
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Dislocations   Dislocations
D025 Acromio/Sterno-clavic-closed red'n with anesth 134.55   D015 Glenohumeral–closed red'n 49.20
D014 Acromio/Sterno-clavic-no red'n 67.80   D016 Glenohumeral with anesthesia 111.40
D035 Ankle – closed red'n 111.35   D004 Metacarpal/phalangeal – closed red'n 57.50
D042 Hip – closed 268.25   E577 Metacarpal (additional) 10.25
D007 Carpal – closed red'n 128.05   D040 Patella – closed red'n 62.20
D012 Elbow (pulled)-radial head – closed red'n 39.00   D062 TMJ – closed red'n 51.65
D009 Elbow – closed red'n 84.45   D027 Toe – closed red'n 57.50
D001 Finger – closed red'n 57.50   E578 Toe (additional) 10.25
E573 Finger (additional) 10.25  
 
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Fractures   Fractures
F074 Ankle: no red'n–rigid immob 67.75   F056 Phalanx (foot): no red'n 49.20
F075 Ankle: closed red'n 144.80   E560 Phalanx (foot): each additional 12.05
F102 Carpus: no red'n 49.20   F004 Phalanx (hand): no red'n/rigid immob. 49.20
F027 Colles: no red'n – rigid immobilization 67.75   F005 Phalanx (hand): closed red'n 99.25
F028 Colles: closed red'n 109.45   E558 Phalanx (hand): each additional 22.25
F082 Fibula: no red'n – rigid immobilization 67.75   F007 Phalanx open fracture 248.70
F053 Humeral neck: no red'n rigid immob 67.80   F024 Radius & ulna: no red'n 67.75
F042 Humeral shaft: no red'n – rigid immob 67.80   F031 Radius or ulna: no red'n 67.75
F008 Metacarpal: no red'n/rigid immob 49.20   F032 Radius or ulna: closed red'n 117.85
F009 Metacarpal: closed red'n 99.25   F018 Scaphoid: rigid immob. 49.20
F061 Metatarsus – no red'n – rigid immob 49.20   F078 Tibia: no red'n – rigid immob. 115.95
F136 Nasal bones, w manip of nasal septum: closed red'n  102.35   F079 Tibia (c or s fib) closed red'n 180.05
F034 Olecranon: no red'n 126.25   F039 Transcondylar/condylar: no red'n 67.75
F070 Calcaneus: no red'n-rigid immob 97.35  
 
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Procedural Sedation

Special Units   Special Units
E020C Emergency Case (ASA III only) 4.00   E022C ASA III 4.00
E009C Age 29 Days-1 year 2.00   E017C ASA IV 10.00
E019C Age 1-8 Years 2.00
E007C Age 70-79 Years 1.00   Time Premiums
E018C Age > 80 Years 2.00   E400C Monday-Friday 17:00-24:00 hrs +50%
E010C BMI > 45 2.00   E400C Sat/Sun/Holiday 07:00-24:00 hrs +50%
E011C Prone position 4.00   E401C Nights Everyday 24:00-07:00 hrs +75%
 
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Common Procedures

Fracture Reductions   Dislocations   Lacerations / Wounds
F110C Clavicle   D025C AC or SC Joint   Z144C Wound debride
F043C Humerus   D016C Glenohumeral (shoulder)   Z176C Simple up to 5cm
F032C Radius and/or Ulna   D009C Elbow   Z175C Simple 5.1-10cm
F046C Colles'/Smith's   D012C Pulled Elbow   Z179C Simple 10.1-15cm
F009C Metacarpals   D007C Carpal   Z191C Simple >15cm
F005C Phalanx Finger   D004C MCP   Z154C Comp/Face up to 5cm
F097C Femur   D001C Finger   Z177C Comp/Face 5.1-10cm
F079C Tibia +/- Fibula   D042C Hip   Z190C Comp/Face 10.1-15cm
F083C Fibula   D038C Knee   Z192C Comp/Face >15cm
F075C Ankle   D031C Patella   R024C Earlobe laceration
F071C Calcaneous   D035C Ankle   R525C Muscle repair
F063C Metatarsals   D030C MTP Joint Foot   P036C Vaginal laceration
F058C Phalanx Toe   D027C Toe  
F136C Nasal bones   D062C TMJ  
 
I&D   FB Removal   Other
Z102C Skin   Z115C Skin   Z804C Lumbar puncture
Z107C Pilonidal/ischiorectal   R51 7C Muscle   Z341C Chest tube
Z105C Perianal   Z852C Eye   Z437C Cardioversion
Z545C Hemmorhoid   Z866C Ear  
Z108C Palmar/plantar   Z312C Nose  
Z140C Breast   Z735C Vagina  
Z506C Oral   Z541C Rectum  
Z301C Nose  
Z715C Bartholin's  
 
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Forms   Holidays
K070 Completion of home care request form 17.45   Boxing Day-Canada Day-Christmas
K071 Acute Home Care Supervision (max 1/2wks for first 12 wks, following admission to home care program )  It is probably billable if the patient has to come back to the ED (after being set up with Home Care-K070) for follow-up, because he/she doesn't have a family physician 10.95   Civic Holiday-Good Friday-Labour Day
K035 Completion of MOT form 34.95   New Years Day-Thanksgiving-Victoria Day
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Category: Billing