Basic assessment billing codes

For the first week of doing this, I thought I would outline the basic assessment billing codes. Don’t forget to change your codes by time of day and day of the week.

[B]Weekdays 08:00-17:00 bill

  • H101 - for Minor Assessment
  • [B]H103 -[/B] for Assessment of more than one body area or region or more than one body system.
  • [B]H102[/B] - for Comprehensive Assessment and Care. This service requires a full history (including systems review, past history, medication review and social/domestic evaluation), a full physical examination, concomitant treatment, and intermittent attendance on the patient over many hours as warranted by the patient’s condition and ongoing evaluation of response to treatment.

It also includes any necessary liaison with the following: the family physician, family, other institution (e.g. nursing home), and other agencies (e.g. Home Care, VON, CAS, police, or detoxification centre).

[Note: Re-assessments, where required, are payable in addition to this service if criteria are met.

  • [B]H104[/B] for Reassessments done at least two hours after initial or previous reassessment. Needs a brief timed note, and cannot be billed at time of referral or discharge [B]with the exception of a reassessment done at discharge by a [I][U]different[/U][/I] MD.[/B]

[B]Weekdays 17:00-23:59 bill[/B]

  • H13x

[B]Nights every day from 24:00 to 07:59 bill[/B]

  • H12x

[B]Weekend and Statutory holidays 08:00-23:59 bill [/B]

  • H15x

One final comment. Don’t forget to bill procedures in addition to the assessment fees. For those of you who want to do so, here is a link to the Schedule of Benefits See page 9 under Consultations and Visits for the Emergency Department codes and associated fees.


Jon :slight_smile: