1What Is the H122 OHIP Code?
The H122 billing code is designated for comprehensive assessments and care provided by family physicians in an emergency department setting overnight, specifically between 00:00h and 08:00h. This assessment covers a complete history, examination, and management plan for patients presenting with acute conditions such as chest pain or abdominal pain that cannot wait until morning.
This billing code is essential for ensuring patients receive timely evaluations and care during hours when fewer healthcare resources may be available. Due to its specific timing requirement, it may be easily missed or incorrectly billed if the timing of the service does not align with the stipulated timeframe.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | Refer to general guidelines | Available for comprehensive consultations conducted via video in a general family practice setting. |
| A006 | Repeat consultation | Refer to general guidelines | Used for repeated consultations in a general practice setting. |
| A010 | GP focused practice consultation by Video | Refer to general guidelines | Applies to consultations via video within general family practice. |
| A011 | GP focused practice repeat consultation by Video | Refer to general guidelines | Supports repeated video consultations within general family practices. |
3Eligibility Requirements
Billing for the H122 is governed by the Family Practice & Practice In General listing with specific eligibility requirements outlined in the OHIP Schedule of Benefits. It must be performed exclusively in an emergency department setting between midnight and 8 AM. It's essential to follow the General Preamble assessment rules regarding frequency rather than relying on an annual cap. Physicians should ensure that the service aligns with these criteria to ensure appropriate reimbursement.
4What Your Clinical Note Must Show
Ensure comprehensive documentation covers:
- Patient's complete medical history
- Thorough physical examination notes
- Detailed management plan
- Exact time of service delivery to confirm eligibility within the 00:00h to 08:00h window
5Weak vs. Strong Note Examples
The strong note succeeds due to detailed documentation of the patient's history, examination, management plan, and the specific timing of care, effectively meeting all criteria for billing the H122 code.
Patient presented with abdominal discomfort. Examined and advised rest. Discharged at night.
Patient presented at 02:15h with acute lower abdominal pain. Full history taken including onset, duration, and associated symptoms. Physical examination showed guarding in the lower quadrants. Blood work and imaging requested. Management plan established focusing on pain relief and further imaging by morning. Discharged with instructions and follow-up scheduled.
- Explicit time of service and presentation
- Detailed history and examination findings
- Clear management plan
