Location (where did your initial consult take place?): ER; Ward
Type (the type of consult): General; Comprehensive; Limited; Repeat (there are others)
Time (time of day you did the consult): Weekday 7:00-17:00; Weekday 7:00-17:00 during Office Hours; Evening Weekday 17:00-24:00; Weekend/Holidays 7:00-24:00; Nights 00:00-7:00
Travel (did you have to travel to go see the patient): Yes; No
Depending on your answers from above we can determine which fee codes to bill to the Ministry of Health for the initial consult. Using your answers follow the breakdown below to find out which codes you need to bill. The first half is for ER visits while the second half covers Ward visits.
If ER is chosen as location and…
·Type is:
o General = A135A
o Comprehensive= A130A
o Limited= A435A
o Repeat= A136A
· Time is:
o if Travel=YES (if you had to travel then no matter the time of day you can bill for your travel and first person seen premiums shown below, known as your special visit premiums)
§ Weekday 7:00-17:00 = K960A, K990A
§ Weekday 7:00-17:00 during Office Hours = K961A, K992A
§ Evening Weekday 17:00-24:00 = K962A, K994A
§ Weekend/Holidays 7:00-24:00 = K963A, K998A
§ Nights 00:00-7:00 = K964A, K996A
o if Travel=NO (if you did not travel then you can only bill for your first person seen premium shown below; however if you saw the patient during the week from 7:00-17:00 you can't bill for the first person seen premium)
§ Weekday 7:00-17:00: nothing
§ Weekday 7:00-17:00 during Office Hours: K992A
§ Evening Weekday 17:00-24:00: K994A
§ Weekend/Holidays 7:00-24:00: K998A
§ Nights 00:00-7:00: K996A
· If you admitted the patient add: E082A
If Ward is chosen and…
·Type is: (Use these codes, but if both Travel=NO and Time=Weekday 7:00-17:00, use the codes listed after this)
o General = A135A
o Comprehensive= A130A
o Limited= A435A
o Repeat= A136A
·Type if Travel=NO and Time=Weekday 7:00-17:00: (Essentially all your codes listed above now start with 'C' instead of 'A')
o General = C135A
o Comprehensive= C130A
o Limited= C435A
o Repeat= C136A
·Time is:
o if Travel=YES (if you had to travel then no matter the time of day you can bill for your travel and first person seen premiums shown below, known as your special visit premiums)
§ Weekday 7:00-17:00: C960A, C990A
§ Weekday 7:00-17:00 during Office Hours: C961A, C992A
§ Evening Weekday 17:00-24:00: C962A, C994A
§ Weekend/Holidays 7:00-24:00: C963A, C986A
§ Nights 00:00-7:00: C964A, C996A
o if Travel=NO (if you did not travel then you can only bill for your first person seen premium shown below; however if you saw the patient during the week from 7:00-17:00 you can't bill for the first person seen premium)
§ Weekday 7:00-17:00: nothing
§ Weekday 7:00-17:00 during Office Hours: C992A
§ Evening Weekday 17:00-24:00: C994A
§ Weekend/Holidays 7:00-24:00: C986A
§ Nights 00:00-7:00: C996A
Initial visit: determined using the logic above
Day after admission: C122A + E083A (The E083A is the premium if you are the most responsible physician for the patient)
Day 2 after admission: C123A +E083A
From Day 3 after admission to discharge: (Note that you use a different code for these subsequent visits, depending on when you are seeing the patient relative to their admission date. There are restrictions on how many times you can use C137A and C139A).
- C132A (if 5 weeks from admission) +E083A
- C137A (if 6-13 weeks from admission) + E083A
- C139A (if past 13 weeks from admission) + E083A
Discharge: C124A + E083A
Our Mo-Billing app actually auto-generates all these codes for you given you provide the admission date, the first day you saw the patient, the last day you saw the patient and whether this was the day of discharge and the location, type, time and travel of the initial consult. To help with the understanding here are 3 examples right from our Mo-Billing app:Example 1
Admission Date: Feb 15 2014
First Seen Date: Feb 15 2014 (Day of initial consult, the first day you saw the patient)
Last Seen Date: Feb 20 2014 (Last date you saw the patient, it is also the discharge date)
Enable autogeneration of codes: activated
Location: ER
Type: General
Time: Weekday 07:00-17:00
Travel: Yes
Feb 15 2014 : A135A (ER and General), K960A, K990A (ER, Weekday 07:00-17:00, Travel=YES), E082A
Feb 16 2014: C122A , E083A (day1 after admission)
Feb 17 2014: C123A, E083A (day2 after admission)
Feb 18 2014: C132A, E083A (I know to use the code for within 5 weeks from admission code since Feb 18 2014 is only 3 days after the date of admission so it falls within this category. If the date was April 5 2014 then I would use the code C137A, E083A since this date falls within 6-13 weeks after the admission date)
Feb 19 2014: C132A, E083A
Feb 20 2014: C124A, E083A (since the last seen date is the same as discharge otherwise I would use C132A again)
Claim Example 2
Admission Date: Feb 15 2014
First Seen Date: April 15 2014 (first day you saw the patient, not the same as admission date)
Last Seen Date: April 20 2014 (last day you saw the patient, not the discharge date)
Enable autogeneration of codes: activated
Location: Ward
Type: Comprehensive
Time: Nights 00:00-07:00
Travel: No
April 15 2014 : A130A (Ward, Comprehensive, Travel=NO), C996A (Ward, Nights 00:00-07:00, Travel=NO)
April 16 2014: C137A , E083A (I know to use the code for within 6-13 weeks from admission since April 16 2014 is 8 weeks and 3 days after the date of admission so it falls within this category. If the date was Sept 5 2014 then I would use the code C139A, E083A since this date falls after 13 weeks from the admission date)
April 17 2014: C137A, E083A
April 18 2014: C137A, E083A
April 19 2014: C137A, E083A
April 20 2014: C137A, E083A (since the last seen date is not the same as discharge)
Claim Example 3
Admission Date: Feb 15 2014
First Seen Date: Feb 15 2014 (first day you saw the patient, the same as admission date)
Last Seen Date: Feb 15 2014 (last day you saw the patient, the same as discharge date)
Enable autogeneration of codes: activated
Location: Ward
Type: Repeat
Time: Weekday 7:00-17:00
Travel: No
Feb 15 2014 : C136A (Ward, Repeat, Travel=No)
Note: All this information was obtained from documents made publicly available by the MOHLTC. We are not to be held liable for any occurrences that arise from following our understanding of medical billing.
Note: All this information was obtained from documents made publicly available by the MOHLTC. We are not to be held liable for any occurrences that arise from following our understanding of medical billing.
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