Knowing which fee codes are available within your specialty is an important aspect of billing correctly. If you’re an anesthesiologist then submitting claims can be a bit more complicated than other specialties since fee codes don’t always have a set price, as they differ depending on time units or your patient’s BMI. Thus, it’s really important to make sure you calculate time units correctly in order to avoid rejections. In an attempt to make things easier, we’ve created a cheat sheet that lists all of the OHIP fee codes available for Anaesthesia. Go ahead and bookmark this page for a quick referencing, or for a downloadable PDF scroll to the bottom. Here’s what you’ll find in the cheat sheet: Anaesthesia OHIP Billing Guidelines for Consultations & Assessments In Patient Anaesthesia OHIP Billing Codes In Patient: Special Visit Premium Emergency Department: Special Visit Premium Out Patient Anaesthesia OHIP Billing Codes Subsequent Visits Subsequent Visits by the MRP Subsequent Visits by MRP following transfer from and ICU Anaesthesia During a Procedure or Surgery Anaesthesia Premiums (after hours & Special visits) Anaesthesia Extra Units Anaesthesia for Nerve Block Procedures Downloadable PDF file OHIP billing codes Searchable Database hbspt.cta.load(6737675, '45593e37-2a27-4843-921c-31d588c67142', {"region":"na1"}); Anaesthesia OHIP Billing Guidelines for Consultations & Assessments Consultations are allowed 1 per 12-month period. Requirements: written request from a referring physician or nurse practitioner.***2nd Consultation is payable in a 12-month period if the diagnosis is completely different than the first. Repeat Consultations are allowed 1 per 12-month period, following a consultation pertaining to the same diagnosis. Requirements: written request from a referring physician or nurse practitioner. Limited Consultations are allowed 1 per 12-month period. Requirements: written request from a referring physician or nurse practitioner. General Assessments are allowed 1 per 12-month period. Requirements: less time spent with the patient than a consultation. General Re-assessments are allowed 2 per 12-month period. Partial Assessments are unlimited. In Patient Anaesthesia OHIP Billing Codes C015 Consultation C215 Limited Consultation C016 Repeat Consultation C013 Medical Specific Assessment C014 Medical Specific Re-Assessment In Patient: Special Visit Premium When using a premium for time and travel make sure you always use the ‘A’ prefix. The “C” prefix consult codes are strictly for non-emergency inpatient consults (and therefore no special visits apply). Weekdays Mon. – Fri. “Sacrifice of Office hours” Evenings Mon. – Fri. Weekends & Holidays Nights Travel Premium C960 : $36.40 Max. 2 C961 : $36.40 Max. 2 C962 : $36.40 Max. 2 C963 : $36.40 Max. 6 C964 : $36.40 Unlimited First Person Seen C990 : $20.00 Max. 1 C992 : $40.00 Max. 1 C994 : $60.00 Max. 1 C986 : $75.00 Max. 1 C996 : $100.00 Unlimited Additonal Person(s) Seen C991: $20.00 Max. 9 C993: $40.00 Max. 9 C995: $60.00 Max. 9 C987: $75.00 Max. 19 U997: $100.00 Unlimited Emergency Department: Special Visit Premium Use the ‘A’ prefix and add a premium for time and travel if you were outside the hospital when called. Weekdays Mon. – Fri. “Sacrifice of Office hours” Evenings M-F Weekends & Holidays Nights Travel Premium K960 : $36.40 Max. 2 K961 : $36.40 Max. 2 K962 : $36.40 Max. 2 K963 : $36.40 Max. 6 K964 : $36.40 Unlimited First Person Seen K990 : $20.00 Max. 1 K992 : $40.00 Max. 1 K994 : $60.00 Max. 1 K998 : $75.00 Max. 1 K996 : $100.00 Unlimited Additonal Person(s) Seen K991: $20.00 Max. 9 K993: $40.00 Max. 9 K995: $60.00 Max. 9 K999: $75.00 Max. 19 K997: $100.00 Unlimited Out Patient Anaesthesia OHIP Billing Codes A015 Consultation A215 Limited Consultation A016 Repeat Consultation A013 Medical Specific Assessment A014 Medical Specific Re-Assessment Subsequent Visits C012 Every day for the first 5 weeks – add E083 if MRP. C017 Week 6 to 13 maximum 3 per week – add E083 if MRP. C019 After week 13 maximum 6 per month – add E083 if MRP. Subsequent Visits by the MRP C122 Day following hospital admission – add E083. C123 Day 2 following hospital admission – add E083. C124 Day of discharge – add E083 if the patient in hospital for at least 48 hours. Subsequent Visits by MRP following transfer from and ICU 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. C121 Intercurrent illness – diagnosis must be totally different than admission diagnosis. C018 Concurrent Care (allowed 4 the first week then 2 every week after). C982 Palliative Care – add E083 if MRP. Anaesthesia During a Procedure or Surgery Calculation of Fee Payable = Basic and Time Units. 1 Unit fee = $15.01. Assisting at Surgery and Anaesthesia Time Units Table Time in Minutes [Hours] Assistant Time Units for Billing Anaesthesia Time Units for Billing 0-15 1 1 15-30 2 2 30-45 3 3 45-60 4 4 60-75 (1h – 1h 15m) 6 6 75-90 (1h 15m – 1h 30m) 8 8 90-105 (1h 30m – 1h 45m) 10 11 105-120 (1h 45m – 2h) 12 14 120-135 (2h – 2h 15m) 14 17 135-150 (2h 15m – 2h 30m) 16 20 150-165 (2h 30m – 2h 45m) 19 23 165-180 (2h 45m – 3h) 22 26 180-195 (3h – 3h 15m) 25 29 195-210 (3h 15m – 3h 30m) 28 32 210-225 (3h 30m – 3h 45m) 31 35 225-240 (3h 45m – 4h) 34 38 240-255 (4h – 4h 15m) 37 41 255-270 (4h 15m – 4h 30m) 40 44 270-285 (4h 30m – 4h 45m) 43 47 285-300 (4h 45m – 5h) 46 50 300-315 (5h – 5h 15m) 49 53 315-330 (5h 15m – 5h 30m) 52 56 330-345 (5h 30m – 5h 45m) 55 59 345-360 (5h 45m – 6h) 58 62 360-375 (6h – 6h 15m) 61 65 375-390 (6h 15m – 6h 30m) 64 68 390-405 (6h 30m – 6h 45m) 67 71 405-420 (6h 45m – 7h) 70 74 420-435 (7h – 7h 15m) 73 77 435-450 (7h 15m – 7h 30m) 76 80 450-465 (7h 30m – 7h 45m) 79 83 465-480 (7h 45m – 8h) 82 86 480-495 (8h – 8h 15m) 85 89 495-510 (8h 15m – 8h 30m) 88 92 Anaesthesia Premiums After-hours Premiums E400C Evening Premium 1700-2400hrs Mon to Fri, daytime or evenings on Sat Sun and Holidays. Adds 50% to each fee code. E401C Night Premium 0000-0700hrs Adds 75% to each fee code. Special Visit Premiums C998C Evening Premium 1700-2400 Mon-Fri or for non-elective surgery with sacrifice of office hours weekday. Maximum of 2 per shift. C985C Sat, Sun or holidays Daytime and Evenings 0700-2400hrs. Maximum of 6 per shift. C999C Nights 0000-0700hrs. Maximum: Unlimited. Check out our article for more on how special visit premiums work and how to claim them. Anaesthesia Extra Units Fee Code Description 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 from 1 year to 8 years of age. 2 units E007C 70-79 year old adult. 1 unit E018C 80 plus years old. 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 great than 60 degrees. 4 units E025C Unanticipated massive transfusion (at least one blood volume of red blood cells). 10 units E012C Patient who is known to have malignant hyperthermia. 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 24hrs with or without operation. 20 units E020C ASA E Patient undergoing anesthesia for emergency surgery which commences within 24 hours of operating room booking to E022C, E017C or E016C. 4 units **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 Fee Code Description Units E030C Procedural sedation. 4 units E031C General anesthesia or deep sedation. 4 units E030C and E031C are not payable with the above list of “Extra Units.” Replacement of Listed Basic Units Fee Code Description Units E650C When a pump is used in conjunction with an anesthetic. 28 units E645C Off pump coronary artery bypass grafting, to R742 or R743. 40 units E002C When hypothermia is used by the anesthesiologist in procedures not specifically identified as required hypothermia. 25 units E013C When anesthetic management is required for emergency relief of acute upper airway obstruction. 10 units Z432C is not payable for an anesthesia service in support of a nerve block. Anaesthesia OHIP Billing Codes ‘Cheat Sheet’ Downloadable PDF file If you’re interested in other OHIP fee codes, make sure to save a link to our OHIP searchable database below. You can search by speciality, billing code or keyword. OHIP billing codes Searchable Database Final Takeaway: Remember you have the option of ” starring” your most commonly used billing codes. That way, they’ll appear at the top for searching. Contact us if you have any questions regarding Anaesthesia Billing codes. Looking to maximize your billing? Check out The Ultimate OHIP Billing Guide for more tips, tricks and automated features! This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates. Related posts: How to Avoid Common OHIP Billing Mistakes OHIP extends temporary payments for Selected Premiums and Management Fees Retroactive Increases to Physician Laboratory Fees I am a one-person team, so it is invaluable to me that Dr.Bill offers a billing support team. It’s like having my own medical billing assistant whenever I need help. Read more
Already an MDBilling.ca client? It’s business as usual and you’ll still be using the same product you’ve come to know and trust for your medical billing. Click here to sign in to your MDBilling.ca account as you normally would.
Looking for MDBilling.ca? You’re in the right place! Dr.Bill and MDBilling.ca have come together to make it even easier to find the right codes, submit claims and get paid.