Emergency OHIP Fee Codes

  

Assessments
Weekday (0800-1700) Weekday Evening (1700-2400)
H101 Minor 17.10 H131 Minor 20.95
H102 Comprehensive 43.05 H132 Comprehensive 52.55
H103 Multi-System 40.00 H133 Multi-System 47.45
H104 Re-assessment 17.10 H134 Re-assessment 20.95
Weekend/Holiday 0800-2400 Night (0000-0800)
H151 Minor 26.35 H121 Minor 30.70
H152 Comprehensive 66.15 H122 Comprehensive 76.95
H153 Multi-System 58.90 H123 Multi-System 68.00
H154 Re-assessment 26.35 H124 Re-assessment 30.70
Premiums (use with G or K but NOT H codes) Procedure Premiums (for use with procedures)
H112 Nights: 0000-0800 35.15.35 E412 Weekday 1700-0000 & Weeknd 0800-0000 +20%
H113 Day/Eve: 0800-2400 (Sat, Sun, Holidays) 20.35 E413 Nights (0000-0800) +40%
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Critical Care Critical Care
G521 Life threatenting:1st 15 mins 111.80 G395 Other resus: 1st 15 mins 57.45
G523 2nd 15 mins 57.65 G391 Each 15 mins after (max 2) 30.60
G522 Each 15 mins after (max 4) 38.00

Special Visit Premiums

See GP67 in the SOB for more information
Premium Weekdays Daytime (07-17) Evenings (17-24) M-F Sat, Sun, Hol (07-24) Nights (24-07)
Travel Premium K960 $36.40 (max 2 per time period) K962 36.40 (max 2 per time period) K963 $36.40 (max 6 per time period) K964 $36.40 (no max)
First Person Seen K990 $20.00 K994 $60.00 K998 $75.00 K996 $100.00
Additional Persons Seen K991 $20.00 (max 10 pts per time period) K995 $60.00 (max 10 pts per time period) K999 $75.00 (max 20 pts per time period) K997 $100.00 (no max
Assessments  
A001 Minor assessment 23.75
A007 Intermediate assessment 37.95
A003 General assessment 84.45
A777 Pronouncement & Certification of death 36.85
A771 Certification of death 20.60
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Admissions Consultations
H105 EP admits to other MRP (inpt interim adm) 26.25 H055 FRCP consultation 106.80
C004 EP admits to other MRP at their request 38.35 H065 All other EM consultations 81.25
C933 EP admits and is the MRP 79.90
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 Phone Consults
K005 Mental Health Care (1/2hr)- 2 Dx req’d w H code 67.75 K734 Phone consult ER to other MD >10min, no live consult 31.35
K013 Counselling/education (per ½ hr) 67.75 K735 Consultant ER MD providing recommendations re: tx/mx; > 10 min 40.45
K015 Counselling relatives re terminally ill (per ½ hr) 62.75 K034 Phone reporting to MOH reportable disease 36.00
K028 Needle stick or STD counselling 67.75 K080 Phone call to patient regarding dx/mx. Documentation req’d (temp) 23.75
K623 Form 1 Mental Health Assessment 113.35 K736 Criticall Consult- Referring from ER (max 2/pt/day) 31.35
K003 Interview with Children’s Aid Society 62.75 K737 CritiCall – Receiving Consult (max 1/pt/day) 40.45
K061 Taking blood samples in hospital at request of police officer 30.00
E079 Smoking cessation (initial discussion) 15.55
(Counselling not to be billed in conjunction with other consults/visits)
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Respiratory Surg Proc Cardiovascular
Z331 Thoracentesis (dx) 32.45 Z437 Cardioversion 92.45
Z332 Thoracentesis (tx) 59.15 Z443 Transvascular Pacemaker 154.10
Z401 Pericardiocentesis 131.70
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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 33.00 Z312 FB nose, complicated 50.90
Z315 Epistaxis – anterior pack unilateral 15.35 Z324 FB larynx 44.70
Z316 Epistaxis–Ant & Post Pack (uni or bilateral) 35.50 Z324 Laryngoscopy (indirect) 44.70
Z314 Epistaxis–Cautery Unilateral 11.50 Z322 Laryngoscopy (direct w removal of FB) 106.45
E108 Eye enucleation 131.25
Z854 eye lid abscess I&D 60.00 G420 Syringe/curetting ears (uni or bilat) 11.35
Z915 FB ear, simple 10.55 G435 Tonometry 5.10
Z847 FB eye (1) 33.00 S023 Tooth extraction (1) 24.90
Z848 FB eye (2) 45.00 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 8.70
Z595 Drainage cath replace in abdomen 54.05 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 Z535 Sigmoidoscopy 36.80
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IV-Venipuncture IV-Venipuncture
Z459 Arterial puncture–ABG’s 10.20 G379 IV adult 6.15
G268 Arterial line 31.25 G376 IV infant/child 10.20
G269 Central line 31.25 G380 IV cutdown 27.05
Z341 Tube thoracostomy for closed drainage (chest tube) 76.80 Z804 Lumbar puncture 150.00
      Z590 Paracentesis/abd (diagnostic) 31.30
G355 Gastric lavage (diagnostic) 9.60 Z591 Paracentesis/abd (therapeutic) 57.65
G356 Gastric lavage (therapeutic) 33.80 Z763 Peritoneal lavage 38.70
G372 IM, SC injection 3.89 K061 Police Blood Demand 31.05
G370 Injection/aspiration bursa/joint/ganglion (1) 20.25 G489 Venipuncture-adult 3.54
G371 Injection/aspiration bursa/joint/ganglion (>1) 19.90 G482 Venipuncture-child 7.35
G270 Intraosseous line 23.90 G480 Venipuncture-infant 9.90
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Minor Surgery/Subcutaneous Minor Surgery/Subcutaneous
R606 Amputate phalanx hand 161.45 Z101 I&D abscess/hematoma (1) 25.75
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 76.80 G211 Intubation (ET) 28.80
Z122 Cyst removal face/neck – one 38.50 R525 Muscle repair (complex) ltr to MOH, I.C. 0.00
Z123 Cyst removal face/neck – two 67.80 Z128 Nail ingrown (simple/wedge) 33.10
Z124 Cyst removal face/neck->3 78.00 Z129 Nail ingrown (multiple) 35.70
Z153 (wrong code) Debride & dress burns – major (unable to bill Z176) 14.05 Z130 Nail removal radical 62.75
Z520 Gastrostomy-tube change 10.65 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
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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