Geriatric OHIP Billing Codes ‘Cheat Sheet’

Courtney Marie L.
June 28, 2019

Being a geriatric doctor can get challenging as patients are more likely to have multiple chronic conditions, each one contributing to their overall quality of life, in addition to the normal aging process.

On top of that, having multiple conditions can make billing a bit more confusing.

So, to help save you some time, we’ve put together a geriatric 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 you find this useful and that it allows you to spend less time on billing and more time on patient care.

Don’t forget to bookmark it! For a printable PDF scroll to the bottom.


Geriatric 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.

 

Outpatient Geriatric OHIP Billing Codes

A075 Extended Comprehensive Geriatric Consultation

A070 Consultation in association with special visit to a hospital in-patient, long-term care in-patient or emergency department patient.

Claim A070 with the C premium for inpatient, W premium for long term care and K premium for emergency.

TIP: Always use the “A” prefix general listing visit codes. The “C” prefix consult codes are strictly for non-emergency inpatient consults (and therefore no special visits apply).

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

 

Long Term Care Facility: Special Visit Premium

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

 

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

Geriatric Outpatient Continued…

A775 Comprehensive Geriatric Consultation

  • Patient at 65 years of age
  • Diagnosis: Dementia
  • You spend at least 75 minutes with the patient
  • Billable only every 2 years

A770 Extended Comprehensive Geriatric Consultation

  • Patient at 65 years of age.
  • Diagnosis of Dementia.
  • Physician spends at least 90 minutes with patient.
  • Billable only every 2 years.

A375  Limited Consultation

A076  Repeat Consultation

A073  Medical Specific Assessment

A074  Medical Specific Re-Assessment

A071  Complex Medical Specific Re-Assessment

A078 Partial Assessment

E078 Chronic Disease Assessment Premium

  • 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 then applies 50% to the assessment code you’ve added it to. For a tutorial on how to use it check out this article.

K077 Geriatric Telephone Support

  • Telephone support for caregivers for a patient with a diagnosis of dementia.
  • Maximum of 2 units per patient per day.
  • Maximum of 8 units per patient per 12 month period.

K032 Specific Neurocognitive Assessment

K035 Mandatory Reporting Medical Condition to MTO

 

In Patient Geriatric OHIP Billing Codes

C075 Consultation

C775 Comprehensive Geriatric Consultation

  • Patient at 65 years of age.
  • Diagnosis: Dementia.
  • You spend at least 75 minutes with the patient.
  • Billable only every 2 years.

C770 Extended Comprehensive Geriatric Consultation

  • Patient at 65 years of age.
  • Diagnosis: Dementia.
  • You spend at least 75 minutes with the patient.
  • Billable only every 2 years.

C375  Limited Consultation

C076  Repeat Consultation

C073  Medical Specific Assessment

C074  Medical Specific Re-Assessment

C071 Complex Medical Specific Re-Assessment

 

Subsequent Visit Geriatric OHIP Billing Codes

C072 Every visit for the first 5 weeks.

  • Add E083 if MRP (Most Responsible Physician)The MRP is the physician who admits the patient to the hospital. The MRP can transfer doctors and specialties throughout a patient’s hospital stay, but only one doctor can be the MRP for the patient at one time.

C077  Week 6 to 13, maximum 3 per week (per patient).

C079  After week 13, maximum 6 per month.

 

Subsequent Visit (by MRP) Geriatric 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</h 2>


C142 Day 1 after transfer – add E083.

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.

C078 Concurrent Care

  • 4 are allowed the first week, then 2 every week thereafter.

C982 Palliative Care per visit  – add E083.

 

Long Term Care In Patient Geriatric OHIP Billing Codes

W075  Consultation

W775 Comprehensive Geriatric Consultation

  • Patient at 65 years of age.
  • Diagnosis: Dementia.
  • You spend at least 75 minutes with the patient.
  • Billable only every 2 years.

W770 Extended Comprehensive Geriatric Consultation

  • Patient at 65 years of age.
  • Diagnosis of Dementia.
  • Physician spends at least 90 minutes with patient.
  • Billable only every 2 years.

W375  Limited Consultation

W076 Repeat Consultation

 

Admission Assessments Geriatric OHIP Billing Codes

W272  Admission Assessment Type 1

W274  Admission Assessment Type 2

W277  Admission Assessment Type 3

W279  Periodic Health Visit

W074  General Reassessment

  • May only be claimed 6 months after Periodic Health Visit.

 

Subsequent Visits Geriatric OHIP Billing Codes

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

W073  The first 2 subsequent visits, per patient, per month.

W078  Subsequent visits per month maximum 3 per patient per month.

W972  Palliative care

W121  Intercurrent illness

W010  Monthly management fee (per patient per month).

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: 

E080

G010

G039 

G040 

G041 

G042 

G043 

G202 

G205 

G365 

G372 

G384 

G385 

G394 

G462

K002 

K003 

K008  

K014 

K015 

K031 

K035 

G480 

G489 

G482 

G538 

G590 

G840 

G841 

G842 

G843 

G844 

G845 

G846 

G847 

G848 

H313

K036 

K038 

K682 

K683 

K684 

K730


Geriatric OHIP Billing Codes
‘Cheat Sheet’

 

Downloadable PDF file


If you’re interested in the most commonly used Geriatric OHIP billing codes, make sure to save a link to our OHIP searchable database below.

If you don’t see the code you’re looking for just search for it on the right hand side under
Find any billing code.”

Geriatric 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!

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