H134 OHIP Billing Code: Efficiently Manage Evening Re-assessments

The H134 billing code is used by Ontario family physicians for re-assessments in emergency departments or Hospital Urgent Care Clinics, specifically during evening hours between 17:00 and 24:00 from Monday to Thursday. This code is applicable when further care or investigation is necessary after an initial assessment and at least two hours have passed. Typically, the need for a re-assessment arises when the patient's condition after initial treatment requires further review, such as after analgesia or when test results return.

The re-assessment must be sufficiently documented and time-tracked, making it a commonly missed billing opportunity due to inadequate record-keeping or misunderstanding of code limitations, such as per-day and per-patient billing constraints.

To bill using the H134 code, the following criteria must be met:

• The re-assessment must occur at least two hours after the initial assessment or previous re-assessment in an emergency department or Hospital Urgent Care Clinic.
• The re-assessment must indicate further care or investigation is required and such care must be performed.

Payment Restrictions:

• The service cannot be billed for discharge assessments.
• The service is not eligible if the patient is admitted by the Emergency Department Physician.
• It cannot be billed if it directly leads to a referral for consultation.
• A maximum of three re-assessments per patient per day is allowed.
• A maximum of two re-assessments per physician per patient per day is permitted.

Ensure accurate time recording on the patient's medical record, documenting the start and end time of the service as per General Preamble GP7.