Emergency Department Billing
Emergency care is complex. Understanding how to bill for it shouldn’t be. Explore these resources for an overview of OHIP emergency department billing codes, common visit types, and key considerations for accurate claims submission.
At DoctorCare, we support both hospital departments as well as specialist groups across Ontario. Currently, we assist more than 15 hospital groups in maintaining accurate billing.
Webinar: ER Billing 101
This educational webinar walks through the fundamentals of emergency department billing in Ontario, including commonly used assessment codes, special visit premiums, documentation considerations, and recommendations on how to reduce claim rejections.
Blog: Emergency Department Billing FAQs
This blog answers common questions from physicians about emergency department billing, including when special visit premiums apply, how emergency assessments are billed, and how to avoid common claim errors.
Blog: Navigating the Complexities of Critical Care Billing
OHIP Critical care services require precise documentation and correct code selection. This blog walks through the billing requirements for critical care services, including time thresholds, documentation expectations, and the most commonly used codes.
Quick Reference Guide: Emergency Department Special Visit Premium
A practical, quick reference guide covering the most common OHIP special visit premiums used in emergency department settings, including after-hours, weekend, and holiday premiums.
Designed to support day-to-day billing decisions, this guide helps physicians capture all eligible premiums and avoid missed revenue opportunities.
Downloadable Resource: Emergency Department Billing Sheet
A practical and concise ER billing reference sheet outlining commonly used emergency department assessment codes, premiums, and billing considerations.
This resource is designed to help physicians quickly identify the appropriate OHIP billing codes when delivering emergency care.
Emergency Department Billing - Frequently Asked Questions
Depending on the time of day and day of the week, you may be eligible for:
- K990 – Evening (5 p.m. – midnight)
- K991 – Weekend or holiday (7 a.m. – midnight)
- K992 – Night (midnight – 7 a.m.)
These are billed in addition to your assessment or procedure codes when services are rendered during these periods.
Refer to our ER Special Visit Premiums quick reference guide, for the full list and best practices on special visit premiums billing.
ER special visit premiums may apply when care is delivered during evenings, overnight periods, weekends, or statutory holidays.
Eligibility depends on the timing of the visit and the type of service provided.
Critical care services are typically billed based on the amount of time a physician spends providing intensive care to a critically ill patient.
Accurate documentation of time spent and services performed is essential to ensure claims are accepted.
One of the most common mistakes we see with our physicians is using the wrong special visit premiums for a specific time or day. Beyond this, doctors often forget to add them to their claims, leaving money on the table.
The most common OHIP rejection codes for critical care and procedure codes seen by physicians are M4 errors, which physicians receive on the error report if the maximums for those codes have been exceeded. For H-prefix assessment codes, a common error that physicians sometimes run into is billing a weekend and holiday assessment on a weekday or vice versa, resulting in a V4 error code.
Lastly, we see physicians not challenging some of the rejections they receive. Rejections can be fixed with a manual review and by providing supporting documentation. For example, including multiple fractures on different limbs or when a physician provides an assessment and critical care on the same day for the same patient.
