Anaesthesia OHIP Billing Codes ‘Cheat Sheet’

 

Anaesthesia OHIP Billing Codes ‘Cheat Sheet’


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

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
0-1511
15-30 22
30-45 33
45-60 44
60-75 (1h – 1h 15m) 66
75-90 (1h 15m – 1h 30m)88
90-105 (1h 30m – 1h 45m) 1011
105-120 (1h 45m – 2h)1214
120-135 (2h – 2h 15m) 14 17
135-150 (2h 15m – 2h 30m)1620
150-165 (2h 30m – 2h 45m)1923
165-180 (2h 45m – 3h)2226
180-195 (3h – 3h 15m) 2529
195-210 (3h 15m – 3h 30m) 2832
210-225 (3h 30m – 3h 45m) 31 35
225-240 (3h 45m – 4h)3438
240-255 (4h – 4h 15m) 3741
255-270 (4h 15m – 4h 30m)4044
270-285 (4h 30m – 4h 45m) 4347
285-300 (4h 45m – 5h) 46 50
300-315 (5h – 5h 15m)4953
315-330 (5h 15m – 5h 30m) 5256
330-345 (5h 30m – 5h 45m)5559
345-360 (5h 45m – 6h) 5862
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!