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

Courtney Marie L.
Feb. 26, 2019
4-minute read

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 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. 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. 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.

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.

  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.  

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Courtney Marie L
Writer and editor with a demonstrated history of working in the Canadian healthcare sector and the publishing industry. Skilled in writing, editing, proofreading, Spanish to English translation, and teaching English as a second language. Strong communications professional with a Bachelor of Arts in Geography and Political Science from the University of Manitoba.
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