1What Is the H133 OHIP Code?
The H133 OHIP billing code is designated for Multiple Systems Assessments typically in Family Medicine. It allows physicians to bill for comprehensive evaluations when multiple body systems are assessed. This code is particularly relevant in the emergency department setting, specifically during weekday evenings when patient volume increases after regular clinic hours. For example, a diabetic patient presenting with a fever and foot ulcer may require both wound inspection and a systemic infection assessment, necessitating a multiple systems approach.
Physicians often miss billing for this code due to oversight in recording sufficient documentation or misunderstanding when a multiple systems assessment qualifies over other consultation codes. It's crucial to ensure that all required elements are thoroughly documented and reflect an examination of multiple body systems.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A914 | GP focused practice comprehensive consultation by Video | As governed by specialty listing | Used for comprehensive video consultations in a focused practice setting. |
| A006 | Repeat consultation | As governed by specialty listing | Used for repeat consultations when assessment has already occurred. |
| A010 | GP focused practice consultation by Video | As governed by specialty listing | Used for video consultations in a focused practice. |
| A011 | GP focused practice repeat consultation by Video | As governed by specialty listing | Used for repeat video consultations in a focused practice. |
3Eligibility Requirements
Eligibility Requirements
To bill for H133 under OHIP, the following criteria must be met as per the General Preamble GP21:
- Location: The service must not be rendered in a patient's home.
- Full History Completion: This includes the history of the presenting complaint, family medical history, past medical history, and social history.
- Functional Inquiry: Complete inquiry into all body parts and systems, excluding breast, genital, or rectal examinations unless medically indicated or refused.
- Examination: An examination of all body systems must be conducted, and may include detailed examination of one or more body parts or systems.
Additionally, as per GP7, the time when the service began and ended must be recorded in the patient's permanent medical record, as the service is not payable without this documentation.
4What Your Clinical Note Must Show
Ensure the following items are recorded in the patient's medical record:
- Start and end time of the service
- Full history including presenting complaint, family history, past medical history, and social history
- Inquiry into all body parts and systems
- Examination of all body systems
5Weak vs. Strong Note Examples
The strong note succeeds by providing a comprehensive history and examination of multiple body systems, fulfilling all documentation requirements. The weak note fails to demonstrate a multi-system inquiry or complete patient history.
Patient presented with fever. Checked vital signs and examined the foot.
Patient presented with a fever and a noted foot ulcer. History includes diabetes, family history of cardiovascular disease, and recent travel. Conducted a thorough examination, evaluating cardiovascular, respiratory, and endocrine systems. Documented systemic infection assessment and specific inquiry into other body systems.
- History includes all required elements.
- Multiple systems are clearly examined and documented.
- Time of service is recorded.
