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).
- Add E083 if MRP
C079 After week 13, maximum 6 per month.
- Add E083 if MRP
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:
- Billing special visit premiums on counselling codes.
- 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
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.
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.
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.
