EM Billing Sheet
Assessments |
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| Weekday (0800-1700) | Weekday Evening (1700-2400) | |||||
|---|---|---|---|---|---|---|
| H101 | Minor | 16.55 | H131 | Minor | 20.65 | |
| H102 | Comprehensive | 41.65 | H132 | Comprehensive | 51.85 | |
| H103 | Multi-System | 39.35 | H133 | Multi-System | 46.80 | |
| H104 | Re-assessment | 16.55 | H134 | Re-assessment | 20.65 | |
| Weekend/Holiday 0800-2400 | Night (0000-0800) | |||||
| H151 | Minor | 26.20 | H121 | Minor | 30.60 | |
| H152 | Comprehensive | 65.70 | H122 | Comprehensive | 76.70 | |
| H153 | Multi-System | 58.50 | H123 | Multi-System | 67.75 | |
| H154 | Re-assessment | 26.20 | H124 | Re-assessment | 30.60 | |
| Premiums (use with G or K but NOT H codes) | Procedure Premiums (for use with procedures) | |||||
| H112 | Nights: 0000-0800 | 20.35 | E412 | Weekday 1700-0000 & Weeknd 0800-0000 | +20% | |
| H113 | Day/Eve: 0800-2400 | 35.15 | E413 | Nights (0000-0800) | +40% | |
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| Critical Care | Critical Care | |||||
|---|---|---|---|---|---|---|
| G521 | Life threatenting:1st 15 mins | 110.55 | G395 | Other resus: 1st 15 mins | 56.80 | |
| G523 | 2nd 15 mins | 55.20 | G391 | Each 15 mins after (max 2) | 28.35 | |
| G522 | Each 15 mins after (max 4) | 36.35 | ||||
| Special Visits (A & K Codes) | Special Visits (A & K Codes) | |||||
|---|---|---|---|---|---|---|
| Emergency Physician (EP)on duty or on call for pre-arranged period/shift: | EP not on duty – not in conjunction with pre-arranged designated period of time on duty | |||||
| 07-1800h max 2 separate special visits | A & K for first pt seen, all subsequent pts billed as H | |||||
| 18-2400h max 3 separate special visits | ||||||
| 00-0700h all separate special visits | Non EP on call/who is detained b/c of high volume | |||||
| all subsequent pts billed with H codes | A & K for first 10 pts seen, all subsequent pts billed as H | |||||
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| Premiums | Assessments | |||||
|---|---|---|---|---|---|---|
| K990 | 0700-1700 1st pt | 18.20 | A001 | Minor assessment | 17.75 | |
| K991 | 0700-1700 subsequent (max) pts | 10.35 | A007 | Intermediate assessment | 30.20 | |
| K994 | 1700-2400 1st pt | 54.55 | A003 | General assessment | 58.20 | |
| K995 | 1700-2400 subsequent (max) pts | 27.30 | A777 | Pronouncement & Certification of death | 30.20 | |
| K996 | 0000-0700 1st pt | 81.85 | A771 | Certification of death | 17.75 | |
| K997 | 0000-0700 subsequent (max) pts | 40.95 | ||||
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| Admissions | Consultations | |||||
|---|---|---|---|---|---|---|
| H105 | EP admits to other MRP (inpt interim adm) | 18.10 | H055 | FRCP consultation | 84.40 | |
| C004 | EP admits to other MRP at their request | 30.70 | H065 | All other EM consultations | 56.25 | |
| C933 | EP admits and is the MRP | 79.20 | ||||
| Detention in Ambulance | ||||||
| Special Visit-Surg Proc (incl frac/disloc not H or G) | K101 | Ground Ambulance (per 15 mins) | 42.10 | |||
| E409 | Eve/Wkd procedures 18-2400h (see GP 60) | +50% | K111 | Air ambulance (per 15 mins) | 126.40 | |
| E410 | Night procedures 24-0800h (see GP 60) | +75% | K112 | Return w/out pt to place of original (pr/30mins) | 25.05 | |
| K001 | Non ambulance (per 15 mins) | 21.10 | ||||
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| Counselling/Mental Health | Phone Consults | |||||
|---|---|---|---|---|---|---|
| K005 | Mental Health Care (1/2hr)- 2 Dx req’d w H code | 67.75 | K734 | Phone consult ER to other MD >10min, no live consult | 31.35 | |
| K013 | Counselling/education (per ½ hr) | 67.75 | K735 | Consultant ER MD providing recommendations re: tx/mx; > 10 min | 40.45 | |
| K015 | Counselling relatives re terminally ill (per ½ hr) | 62.75 | K034 | Phone reporting to MOH reportable disease | 36.00 | |
| K028 | Needle stick or STD counselling | 67.75 | K080 | Phone call to patient regarding dx/mx. Documentation req’d (temp) | 23.75 | |
| K623 | Form 1 Mental Health Assessment | 113.35 | K736 | Criticall Consult- Referring from ER (max 2/pt/day) | 31.35 | |
| K003 | Interview with Children’s Aid Society | 62.75 | K737 | CritiCall – Receiving Consult (max 1/pt/day) | 40.45 | |
| K061 | Taking blood samples in hospital at request of police officer | 30.00 | ||||
| E079 | Smoking cessation (initial discussion) | 15.40 | ||||
| (Counselling not to be billed in conjunction with other consults/visits) | ||||||
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| Respiratory Surg Proc | Cardiovascular | |||||
|---|---|---|---|---|---|---|
| Z331 | Thoracentesis (dx) | 32.45 | Z437 | Cardioversion | 66.00 | |
| Z332 | Thoracentesis (tx) | 59.15 | Z443 | Transverse Pacemaker | 154.10 | |
| Z401 | Pericardiocentesis | 131.70 | ||||
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| OB/GYN | ||||||
|---|---|---|---|---|---|---|
| P009 | Non OBGYN attending L&D/CS resus newborn | 395.75 | ||||
| G365 | Pap smear | 6.75 | ||||
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| Eyes/ENT | Eyes/ENT | |||||
|---|---|---|---|---|---|---|
| Z847 | Chalazion-excision | 26.60 | Z312 | FB nose, complicated | 50.90 | |
| Z315 | Epistaxis – anterior pack unilateral | 15.35 | Z324 | FB larynx | 35.50 | |
| Z316 | Epistaxis–Ant & Post Pack (uni or bilateral) | 35.50 | Z324 | Laryngoscopy (indirect) | 35.50 | |
| Z314 | Epistaxis–Cautery Unilateral | 11.50 | Z321 | Laryngoscopy (direct w removal of FB) | 61.30 | |
| E108 | Eye enucleation | 131.25 | Z322 | Laryngoscopy FB removal (direct) | 106.45 | |
| Z854 | eye lid abscess I&D | 40.90 | G420 | Syringe/curetting ears (uni or bilat) | 11.25 | |
| Z915 | FB ear, simple | 10.55 | G435 | Tonometry | 5.10 | |
| Z847 | FB eye (1) | 26.60 | S023 | Tooth extraction (1) | 24.90 | |
| Z848 | FB eye (2) | 38.00 | E700 | Tooth extraction (each additn’l) | 13.40 | |
| Z845 | FB eye (3 or more) | ??? | Z326 | Tracheostomy tube change | 11.25 | |
| Z311 | FB nose, simple | 10.55 | G403 | Particle Repositioning Manoeuver | 21.15 | |
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| GU/GI | GU/GI | |||||
|---|---|---|---|---|---|---|
| Z543 | Anoscopy | 6.25 | ||||
| Z595 | Drainage cath replace in abdomen | 43.60 | G355 | NG Tube–Diagnostic | 9.60 | |
| Z756 | Fecal disempaction | 36.80 | G356 | NG Tube–Therapeutic | 33.80 | |
| Z611 | Foley catheter | 8.55 | G476 | Prostatic massage | 5.40 | |
| Z520 | Gastrostomy tube change | 8.60 | Z535a | Sigmoidoscopy | 36.80 | |
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| IV-Venipuncture | IV-Venipuncture | |||||
|---|---|---|---|---|---|---|
| Z459 | Arterial puncture–ABG’s | 9.10 | G379 | IV adult | 6.15 | |
| G268 | Arterial line | 31.25 | G376 | IV infant/child | 10.20 | |
| Z269 | Central line | 31.25 | G380 | IV cutdown | 27.05 | |
| Z341 | Chest tube | 62.85 | Z804 | Lumbar puncture | 41.00 | |
| Z341 | Drainage/effusion/pneumothorax | 62.85 | Z590 | Paracentesis/abd (diagnostic) | 25.25 | |
| G355 | Gastric lavage (diagnostic) | 9.60 | Z591 | Paracentesis/abd (therapeutic) | 46.50 | |
| G356 | Gastric lavage (therapeutic) | 33.80 | Z763 | Peritoneal lavage | 38.70 | |
| G372 | IM, SC injection | 2.32 | K061 | Police Blood Demand | 30.00 | |
| G370 | Injection/aspiration bursa/joint/ganglion (1) | 19.90 | G489 | Venipuncture-adult | 2.32 | |
| G371 | Injection/aspiration bursa/joint/ganglion (>1) | 10.00 | G482 | Venipuncture-child | 6.25 | |
| G270 | Intraosseous line | 23.90 | G480 | Venipuncture-infant | 9.25 | |
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| Minor Surgery/Subcutaneous | Minor Surgery/Subcutaneous | |||||
|---|---|---|---|---|---|---|
| R606 | Amputate phalanx hand | 161.45 | Z101 | I&D abscess/hematoma (1) | 20.10 | |
| R660 | Burn: debride & excise (d&e): per hand/each digit | 28.90 | Z173 | I&D abscess/hematoma (2) | 30.35 | |
| R661 | Burn: d&e: dorsum palm-each | 47.95 | Z545 | I&D hemorrhoid | 25.25 | |
| R662 | Burn: d&e: face/scalp/neck each | 28.90 | Z106 | I&D ischiorectal/pilonidal | 44.35 | |
| R637 | Burn: d&e: per % body, not hand,head,neck | 29.65 | Z104 | I&D perianal abscess | 20.10 | |
| Z341 | Chest tube | 62.50 | Z211 | Intubation (ET) | 28.80 | |
| Z122 | Cyst removal face/neck – one | 32.70 | R525 | Muscle repair (complex) ltr to MOH, I.C. | 0.00 | |
| Z123 | Cyst removal face/neck – two | 47.60 | Z128 | Nail ingrown (simple/wedge) | 23.80 | |
| Z124 | Cyst removal face/neck->3 | 65.35 | Z129 | Nail ingrown (multiple) | 35.70 | |
| Z153 | Debride & dress burns – major (unable to bill Z176) | 14.05 | Z130 | Nail removal radical | 62.75 | |
| Z520 | Gastrostomy-tube change | 8.60 | Z401 | Pericardiocentesis | 131.70 | |
| R578 | Ext. tendon repair | 164.40 | R150 | Plastic repair, very minor | 92.30 | |
| R585 | Flexor tendon | 307.60 | R151 | Plastic repair, minor | 140.25 | |
| Z114 | Foreign body removal skin | 18.80 | Z783 | Secondary closure | 97.35 | |
| R517 | foreign body muscle | 107.70 | Z162 | Skin lesion, excise/suture (1) | 14.80 | |
| Z163 | Skin lesion excise/suture (2) | 22.15 | ||||
| Z164 | Skin lesion excise/suture (>3) | 36.90 | ||||
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| Suturing | Nerve Blocks(not paid if used as anesth for J40-43) | |||||
|---|---|---|---|---|---|---|
| E199 | Eyelid repair laceration–Full thick (note: an optho should really do this. Why are you doing this?) | 131.25 | G224 | Block allowed in addition to procedure for: pudendal, femoral, intercostal, sciatic, ilioinguinal, ulnar, median, radial, brachial | 15.55 | |
| Z176 | Laceration under 5cm (@50% for glue/steristrips) | 14.80 | G125 | Epidural for pain relief | 45.75 | |
| Z154 | Laceration under 5cm, face/bleeder/layers | 35.90 | G225 | Mental branch of mandibular nerve | 34.20 | |
| Z175 | Laceration 5.1-10cm | 35.90 | G250 | Maxillary or mandibular division of trigeminal nerve | 75.10 | |
| Z177 | Laceration 5.1-10cm, face/bleeder/layers | 71.30 | G218 | Ilioinguinal and iliohypogastric nerve | 54.65 | |
| Z179 | Laceration 10.1-15cm | 50.40 | G219 | Infraorbital | 34.20 | |
| Z190 | Laceration 10.1-15cm face/bleeder/layers | 101.45 | G220 | Intercostal nerve | 34.20 | |
| Z187 | Complex face repair (must take 20 minutes or more) | G221 | Intercostal nerve – each additional one | 16.95 | ||
| Z188 | Complex repair elsewhere except finger zone 1 repairs (must take 20 minutes or more) | G258 | Intrapleural block (single injection) | 44.25 | ||
| Z189 | Complex finger zone 1 repairs (must take 20 minutes or more) | |||||
| Z783 | Secondary closure | 97.35 | ||||
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ORTHO
| Casts/Splints | Casts/Splints | |||||
|---|---|---|---|---|---|---|
| Z204 | Cast removal | 10.25 | Z213 | Leg below knee/cast splint | 24.10 | |
| Z202 | Hand cast/splint | 14.90 | Z213 | Full leg cast/splint | 24.10 | |
| Z201 | Finger cast/splint | 10.25 | Z208 | Shoulder spica | 97.35 | |
| Z199 | Foot cast/splint | 14.90 | Z198 | Toes/cast splint | 10.25 | |
| Z203 | Forearm cast/splint | 24.10 | Z216 | Wedging of casts in other than # tx | 10.25 | |
| (not billed if fracture code used) | ||||||
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| Dislocations | Dislocations | |||||
|---|---|---|---|---|---|---|
| D025 | Acromio/Sterno-clavic-closed red’n with anesth | 134.55 | D015 | Glenohumeral–closed red’n | 49.20 | |
| D014 | Acromio/Sterno-clavic-no red’n | 67.80 | D016 | Glenohumeral with anesthesia | 111.40 | |
| D035 | Ankle – closed red’n | 111.35 | D004 | Metacarpal/phalangeal – closed red’n | 57.50 | |
| D042 | Hip – closed | 268.25 | E577 | Metacarpal (additional) | 10.25 | |
| D007 | Carpal – closed red’n | 128.05 | D040 | Patella – closed red’n | 62.20 | |
| D012 | Elbow (pulled)-radial head – closed red’n | 39.00 | D062 | TMJ – closed red’n | 51.65 | |
| D009 | Elbow – closed red’n | 84.45 | D027 | Toe – closed red’n | 57.50 | |
| D001 | Finger – closed red’n | 57.50 | E578 | Toe (additional) | 10.25 | |
| E573 | Finger (additional) | 10.25 | ||||
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| Fractures | Fractures | |||||
|---|---|---|---|---|---|---|
| F074 | Ankle: no red’n–rigid immob | 67.75 | F056 | Phalanx (foot): no red’n | 49.20 | |
| F075 | Ankle: closed red’n | 144.80 | E560 | Phalanx (foot): each additional | 12.05 | |
| F102 | Carpus: no red’n | 49.20 | F004 | Phalanx (hand): no red’n/rigid immob. | 49.20 | |
| F027 | Colles: no red’n – rigid immobilization | 67.75 | F005 | Phalanx (hand): closed red’n | 99.25 | |
| F028 | Colles: closed red’n | 109.45 | E558 | Phalanx (hand): each additional | 22.25 | |
| F082 | Fibula: no red’n – rigid immobilization | 67.75 | F007 | Phalanx open fracture | 248.70 | |
| F053 | Humeral neck: no red’n rigid immob | 67.80 | F024 | Radius & ulna: no red’n | 67.75 | |
| F042 | Humeral shaft: no red’n – rigid immob | 67.80 | F031 | Radius or ulna: no red’n | 67.75 | |
| F008 | Metacarpal: no red’n/rigid immob | 49.20 | F032 | Radius or ulna: closed red’n | 117.85 | |
| F009 | Metacarpal: closed red’n | 99.25 | F018 | Scaphoid: rigid immob. | 49.20 | |
| F061 | Metatarsus – no red’n – rigid immob | 49.20 | F078 | Tibia: no red’n – rigid immob. | 115.95 | |
| F136 | Nasal bones, w manip of nasal septum: closed red’n | 102.35 | F079 | Tibia (c or s fib) closed red’n | 180.05 | |
| F034 | Olecranon: no red’n | 126.25 | F039 | Transcondylar/condylar: no red’n | 67.75 | |
| F070 | Calcaneus: no red’n-rigid immob | 97.35 | ||||
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Procedural Sedation
| Special Units | Special Units | |||||
|---|---|---|---|---|---|---|
| E020C | Emergency Case (ASA III only) | 4.00 | E022C | ASA III | 4.00 | |
| E009C | Age 29 Days-1 year | 2.00 | E017C | ASA IV | 10.00 | |
| E019C | Age 1-8 Years | 2.00 | ||||
| E007C | Age 70-79 Years | 1.00 | Time Premiums | |||
| E018C | Age > 80 Years | 2.00 | E400C | Monday-Friday 17:00-24:00 hrs | +50% | |
| E010C | BMI > 45 | 2.00 | E400C | Sat/Sun/Holiday 07:00-24:00 hrs | +50% | |
| E011C | Prone position | 4.00 | E401C | Nights Everyday 24:00-07:00 hrs | +75% | |
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Common Procedures
| Fracture Reductions | Dislocations | Lacerations / Wounds | ||||||
|---|---|---|---|---|---|---|---|---|
| F110C | Clavicle | D025C | AC or SC Joint | Z144C | Wound debride | |||
| F043C | Humerus | D016C | Glenohumeral (shoulder) | Z176C | Simple up to 5cm | |||
| F032C | Radius and/or Ulna | D009C | Elbow | Z175C | Simple 5.1-10cm | |||
| F046C | Colles’/Smith’s | D012C | Pulled Elbow | Z179C | Simple 10.1-15cm | |||
| F009C | Metacarpals | D007C | Carpal | Z191C | Simple >15cm | |||
| F005C | Phalanx Finger | D004C | MCP | Z154C | Comp/Face up to 5cm | |||
| F097C | Femur | D001C | Finger | Z177C | Comp/Face 5.1-10cm | |||
| F079C | Tibia +/- Fibula | D042C | Hip | Z190C | Comp/Face 10.1-15cm | |||
| F083C | Fibula | D038C | Knee | Z192C | Comp/Face >15cm | |||
| F075C | Ankle | D031C | Patella | R024C | Earlobe laceration | |||
| F071C | Calcaneous | D035C | Ankle | R525C | Muscle repair | |||
| F063C | Metatarsals | D030C | MTP Joint Foot | P036C | Vaginal laceration | |||
| F058C | Phalanx Toe | D027C | Toe | |||||
| F136C | Nasal bones | D062C | TMJ | |||||
| I&D | FB Removal | Other | ||||||
| Z102C | Skin | Z115C | Skin | Z804C | Lumbar puncture | |||
| Z107C | Pilonidal/ischiorectal | R51 7C | Muscle | Z341C | Chest tube | |||
| Z105C | Perianal | Z852C | Eye | Z437C | Cardioversion | |||
| Z545C | Hemmorhoid | Z866C | Ear | |||||
| Z108C | Palmar/plantar | Z312C | Nose | |||||
| Z140C | Breast | Z735C | Vagina | |||||
| Z506C | Oral | Z541C | Rectum | |||||
| Z301C | Nose | |||||||
| Z715C | Bartholin’s | |||||||
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| Forms | Holidays | |||||
|---|---|---|---|---|---|---|
| K070 | Completion of home care request form | 17.45 | Boxing Day-Canada Day-Christmas | |||
| K071 | Acute Home Care Supervision (max 1/2wks for first 12 wks, following admission to home care program ) It is probably billable if the patient has to come back to the ED (after being set up with Home Care-K070) for follow-up, because he/she doesn’t have a family physician | 10.95 | Civic Holiday-Good Friday-Labour Day | |||
| K035 | Completion of MOT form | 34.95 | New Years Day-Thanksgiving-Victoria Day | |||
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