OHIP Billing Support - How to Bill E078 (the Chronic Disease Premium)


What is E078?

E078 is the premium fee code for Chronic Disease Assessment. OHIP first added this premium to the Schedule of Benefits back in 2005. The idea behind it was to reimburse doctors who work with chronic disease, as it typically requires more out-patient follow up and overall care and management.

How does it work?

E078 is only payable on certain out-patient assessments and is a percentage-based premium. This means you need to add it to another code in order for it to work. It will then apply 50% to the assessment code you’ve added it to.

For example, let’s say you bill A263 (Medical Specific Assessment) which is $77.70. By adding E078, you’ll get an extra 50%, which will bring the entire assessment to $116.55 (meaning the premium added an extra $38.85).

Assessment Code + 50% Premium Total
A263 = $77.70 E078 = $38.85 $116.55


Who can bill E078?

Of course, there are some restrictions when using it; such as location, specialty, and diagnostic code. For instance, it can only be added as a premium to out-patient assessments only. It’s therefore not applicable for any admitted inpatients, long-term care facility patients or patients in the emergency department.

It’s only eligible under the following specialties:

Geriatrics
Endocrinology & Metabolism
Neurology
Pediatrics
Pathology
Physical Medicine
Therapeutic Radiology
Medical Oncology
Infectious Disease
Respiratory Disease
Rheumatology
Hematology
Clinical Immunology


Additionally, in order to use E078, you have to use it with one of the following diagnostic codes:

042 - AIDS
043 - AIDS-related complex
044 - Other human immunodeficiency virus infection
250 - Diabetes mellitus, including complications
286 - Coagulation defects (e.g. haemophilia, other factor deficiencies)
287 - Purpura, thrombocytopenia, other hemorrhagic conditions
290 - Senile dementia, presenile dementia
299 - Child psychoses or autism
313 - Behavioural disorders of childhood and adolescence
315 - Specified delays in development (e.g. dyslexia, dyslalia, motor retardation)
332 - Parkinson's Disease
340 - Multiple Sclerosis
343 - Cerebral Palsy
345 - Epilepsy
402 - Hypertensive Heart Disease
428 - Congestive Heart Failure
491 - Chronic Bronchitis
492 - Emphysema
493 - Asthma, Allergic Bronchitis
515 - Pulmonary Fibrosis
555 - Regional Enteritis, Crohn's Disease
556 - Ulcerative Colitis
571 - Cirrhosis of the Liver
585 - Chronic Renal Failure, Uremia
710 - Disseminated Lupus Erythaematosus, Generalized Scleroderma, Dermatomyositis
714 - Rheumatoid Arthritis, Still's Disease
720 - Ankylosing Spondylitis
721 - Other seronegative spondyloarthropathies
758 - Chromosomal Anomalies
765 - Prematurity, low-birthweight infant
902 - Educational problems


How to Bill E078 on Dr. Bill

Billing E078 on your iPhone is easy, just follow these steps:

1. Click on “All Patients” and select your patient (Use a Label Snap if it’s a new patient).
2. Click on “New Claim” on the bottom left hand corner.

TRY.png


3. Click on the arrow for “Billing Code.”
4. Select your Assessment Code (our example is A263) and then the premium E078A.

5. Fill out the rest of the claim as normal (Diagnoses, Location, Facility #, etc.) Click Save.
6. This will bring you to a “Confirmation” page, click “save” again.

Premium1.png



And You’re Done!

Now if you go back to the home page and click on “Claims” you should be able to see the assessment code with the premium below it.

Premium Claim.png

Want to maximize your earnings? New to Ontario Billing?

Check out our Ultimate OHIP Billing Guide that takes you through every step for billing successfully in Ontario.