Internal Medicine OHIP Billing Codes ‘Cheat Sheet’

 

Internal Medicine OHIP Billing Codes ‘Cheat Sheet’

Internal Medicine OHIP Billing Codes.jpg

If you’re an internal medicine specialist in Ontario who is managing your own billing, knowing which fee code you can use can sometimes be a major pain.

The complexity of submitting claims to OHIP, on top of your already heavy workload, is bound to cause a few headaches.

To help save you some time, we've put together an internal medicine cheat sheet of the most common OHIP fee codes.

Keep in mind that knowing which codes are available in your speciality is essential in order to maximize your earning potential.

We hope this is a useful resource and lets you spend less time going through the massive fee schedule. Don’t forget to bookmark it! For a printable PDF scroll to the bottom.


Internal Medicine OHIP Billing Guideline 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.

 

Outpatient Internal Medicine OHIP Billing Codes

*Use service location code HOP – facility number of hospital AM

A135 Consultation

A765 Consultation patient 16 years and under.

A130 Comprehensive Consultation – minimum time spent 75 mins. Stop and start times recorded in patient record.

A435 Limited Consultation

A136 Repeat Consultation

A133 Medical Specific Assessment

A134 Medical Specific Re-Assessment

A120 Colonoscopy Assessment – same day as colonoscopy.

K045 Diabetes Management by a Specialist.

  • Maximum of 1 service per patient per 12 month period, eligible for payment if the physician has rendered a minimum of 4 of the following – consultations, assessments, K013, K033, K029, K002, K003 in the 12 month period.

K046 Diabetes Team Management

  • Maximum of 1 service per patient per 12 month period, eligible for payment if the physician has rendered a minimum of 4 of the following – consultations, assessments, K013, K033, K029, K002, K003 in the 12 month period.

 

Visit to Emergence Department for Consultation or Assessment

*Use the A prefix and add a premium for time and travel if you were outside the hospital when called.

Emergency Department: Special Visit Premium

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
 

In Patient Internal Medicine OHIP Billing Codes

Use service location code HIP- admission date - facility number of hospital AT

C135  Consultation

C765  Consultation, patient 16 years of age and under

C130  Comprehensive Internal Medicine Consultation – minimum time spent 75 mins. Stop and start times recorded in patient record.

C435  Limited Consultation

C136  Repeat Consultation

C133  Medical Specific Assessment

C134  Medical Specific Re-Assessment

C131  Complex Medical Specific Re-Assessment

E082 MRP Premium – Add this to Admission consultation or admission assessment.

patient and doctor taking notes
 

In Patient: Special Visit Premium

**When using a premium for time and travel for In Patients make sure the consult/assessment is the prefix A:

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
 

Subsequent Visit Internal Medicine OHIP Billing Codes

C132  First 5 weeks per visit.

C137  6th to 13th week, 3 per week.

C139  After week 13, 6 per month.

E083 MRP Premium – Add to subsequent visits when you are MRP.

 

Subsequent Visit (by MRP) Internal Medicine OHIP Billing Codes

C122  Day 1 following MRP admission – add E083.

C123  Day 2 following MRP 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 Intensive Care Unit

C142 Day 1 after transfer – add E083.

ICU.png

C143 Day 2 after transfer – add E083.

***Note: the patient must be admitted to ICU by a different specialty.

C121  Additional visits due to intercurrent illness.

C138  Concurrent Care.

C982 Palliative Care.

 

Long Term Care In Patient Internal Medicine OHIP Billing Codes

Use service location code HIP – must have admission date- facility number of Long Term Facility

W235  Consultation

W765  Consultation patient 16 years of age and under.

W130  Comprehensive Consultation – same as A130.

W435  Limited Consultation

W236  Repeat Consultation

 

Admission Assessment

W232  Type 1

W234  Type 2

W237  Type 3

W239  Periodic health visit.

W134 General Re-Assessment.

 

Long Term Care Facility: Special Visit Premium

**When using a premium for time and travel for Long Term Patients make sure the consult/assessment is the prefix A.

Weekdays Mon. - Fri. "Sacrifice of Office hours" Evenings Mon. - Fri. Weekends & Holidays Nights
Travel Premium W960 : $36.40 Max. 2 W961 : $36.40 Max. 2 W962 : $36.40 Max. 2 W963 : $36.40 Max. 6 W964 : $36.40 Unlimited
First Person Seen W990 : $20.00 Max. 1 W992 : $40.00 Max. 1 W994 : $60.00 Max. 1 W998 : $75.00 Max. 1 W996 : $100.00 Unlimited
Additonal Person(s) Seen W991: $20.00 Max. 9 W993: $40.00 Max. 9 W995: $60.00 Max. 9 W999: $75.00 Max. 19 W997: $100.00 Unlimited
 

Subsequent Visits

W132 First 4 visits per patient per month

W131 Additional visit (max 6 per patient per month)

W982 Palliative Care

 

Nursing Home or Home for the Aged

internal medicine care.jpg

W133  First 2 visits per patient per month

W138  Subsequent visits per month (max 3 per patient per month)

W972  Palliative Care

W121 Additional visits due to intercurrent illness.

 

Common Billing Mistake: Getting rejections on Counselling Codes


We often see rejections of counselling codes due to the following reasons:

  1. Billing special visit premiums on counselling codes.

  2. Billing counselling (such as K013) on the same bill as an assessment with the same diagnosis code.

Counselling appointments are technically pre-booked and therefore no special visit premiums apply.


However, counselling codes CAN be billed on the same day as an assessment BUT:

  • They need to be on separate claims.

  • They need to have different and unrelated diagnostic codes.

***With the exception of the codes listed below, no other services are eligible for payment when rendered by the same physician on the same day as any type of counselling service.

Exceptions: 


Internal Medicine OHIP Billing Codes
‘Cheat Sheet’
Downloadable PDF file

Printable PDF


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 Internal Medicine Billing codes.


Looking to maximize your billing?

Check out The Ultimate OHIP Billing Guide for more tips, tricks and automated features!