1What Is the A100 OHIP Code?
The A100 billing code refers to the service provided by general or family physicians during an emergency department assessment. It ensures appropriate remuneration for physicians handling emergency cases in a fast-paced environment. The assessment involves a thorough history and examination of the patient to determine the appropriate care pathway. This code is crucial in emergency department settings funded under an ED alternate funding arrangement. Physicians must note that no other service, including premiums, rendered by the same doctor to the same patient at the same visit is claimable under this code. Missing this service during an emergency department shift can result in significant loss of income for physicians, especially if not properly documented or if the hospital master number is omitted from the claim.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | Consultation as needed | Comprehensive video consultations for focused practices. |
| A006 | Repeat consultation | Repeat consultations as necessary | Follow-up consultations for ongoing patient management. |
| A010 | GP focused practice consultation by Video | Initial video consultations per patient need | Initial consultations facilitated via video for GP focused practices. |
| A011 | GP focused practice repeat consultation by Video | Repeat video consultations as necessary | Subsequent video consultations for continued care. |
3Eligibility Requirements
Eligibility Requirements
- Code-Specific Rules: This code applies specifically to general or family physicians conducting assessments in an emergency department funded under an ED alternate funding arrangement (ED-AFA).
- Service Limitations: No concurrent service (e.g., special visit premiums) by the same physician for the same patient during the same emergency visit is covered.
- Submission Details: Ensure the inclusion of the hospital master number associated with the emergency department on the claim form.
- Admission Assessment: If a patient assessed is subsequently admitted and the physician continues as the MRP, the A100 code covers the admission assessment.
- Certification of Death: Requires completion by the physician if declared by another professional, using the relevant diagnostic code.
4What Your Clinical Note Must Show
To claim the A100 code, maintain thorough records of the service period and details.
- Record the start and end time of the assessment.
- Document a full history including presenting complaint, family, and social history.
- Include examinations and findings for all body systems assessed.
Include the hospital master number tied to the emergency department to validate the claim.
5Weak vs. Strong Note Examples
The strong note is successful because it details the comprehensive patient history, full physical examination, and includes the required time records and hospital master number—critical for OHIP claims.
Patient seen in ED, assessment done. No additional info regarding history or exam.
Comprehensive assessment performed in ED. Full patient history taken including presenting complaint, family medical history, social context, and current medications.
Physical examination covered cardiovascular, respiratory, and neurological systems.
- Documented start and end time: 09:00 - 09:30
- Hospital master number recorded correctly
