Special visit

It's Saturday 11pm, you're about to go to bed. The phone rings and it's the nurse on the medical floor. "Mrs. Smith is not doing so well, I think you should come in." Oh darn, you thought finally everyone on the floor was stable...
So you drive in to the hospital and see Mrs. Smith. She was having chest pain but nurses already administered some nitroglycerin spray which has in fact resolved the pain. She is now stable and the physical exam is benign. No changes in ECG. You order some cardiac enzymes and ask the nurses to let you know the result by phone.
Then another nurse finds you. "Great! You're here. You know Mr. Jones, the one with hip fracture, he's having quite a bit of pain." You see him, examine him and adjust the dose of analgesics.
By this time, the enzymes have come back negative. You order second set of enzymes for the morning and drive home.

How would you bill for this scenario? You already rounded on all your patients in the morning and you have billed accordingly for the daily visit codes. This is the time you use the special visit codes with lots of other premiums for all your good work!

For Mrs. Smith:

A007 "Special Visit" ($33.70) - I know, it starts with "A" but this was hospital work! Trust me this is the right code. As to why OHIP chose this to be the right code, don't ask me...

C986 "Hospital special visit premium, Sat/Sun/Holidays" ($75.00) - Note that this is "premium" and it is not a stand-alone code. You need an actual service code, thus A007

C963 "Travel premium, Sat/Sun/Holidays" ($36.40) - You drove in from home, so you get paid for the travel.

For Mr. Jones:

A007 - Just as above

C987 "Additional patient, Sat/Sun/Holidays" ($75.00)- You can't bill C986 twice, but you can use C987 for up to nineteen additional patients. The patient limit differs by the time of day and the day of week. For complete listing see below.

(You cannot bill C963 "Travel premium" as you have seen two patients at the same place. However, if you actually had to drive again, let's say to visit another patient in a nursing home, or you went home and drove back, then you could bill it again. This day being Saturday, you are allowed up to 6 billable trips.)


List of hospital special visit premium:
C990 Weekday 07:00-17:00 (max 10 patients use C991 for additional patients)
C992 Sacrifice Office hours (max 10 patients use C993 for additional patients)
C994 Weekday 17:00-00:00 (max 10 patients use C995 for additional patients)
C996 Night (anyday) 00:00-07:00 (no limit use C997 for additional patients)
C986 Sat/Sun/Holidays 07:00-17:00 (max 20 patients use C987 for additional patients)

List of hospital special visit travel premium:
C960 Weekday 07:00-17:00 (max. 2 trips)
C961 Sacrifice Office hours (max. 2 trips)
C962 Weekday 17:00-00:00 (max. 2 trips)
C964 Night (anyday) 00:00-07:00 (no limit)
C963 Sat/Sun/Holidays 07:00-17:00 (max. 6 trips)