Ontario Health Insurance Plan

INFOBulletin

System solution for E405A effective December 1, 2020.

Allow E405A-Hospital Complexity Modifier payment with extra unit anaesthesiology codes effective December 1 2020.


To: Physicians, Hospitals, Clinics and Laboratories
Category: Physician Services
Written by: Health Services Branch, Ministry of Health
Date issued: December 14, 2020
Bulletin Number: 201202


Background

Further to INFOBulletin 4758 titled ‘Temporary Fees for Identified AGMP Procedures-COVID-19-Hospital Physician Compensation’ and INFOBulletin 201105 titled ‘COVID-19 Hospital Physician Compensation: E405A Changes’ the Ministry of Health (ministry) implemented temporary payments for specified physician services provided in hospital as a result of COVID-19.

Fee Schedule Code (FSC) E405A: COVID Hospital Complexity Modifier was implemented on June 1, 2020 with an effective date of April 3, 2020.

An issue occurred during the implementation of this FSC where E405A was not paying with some anaesthesiology extra unit fee codes.

System solution to pay anaesthesiology fee codes

Please Note: No action is required by physicians.

Effective December 1, 2020, a system solution has been implemented to calculate the amount for the E405A premium when billed with one or more anaesthesiology extra unit fee codes (listed below). The E405A premium will pay at 30% of the fee paid (fee approved for shadow billed claims) for service dates between April 3, 2020 to July 31, 2020.

The eligible anaesthesiology extra unit fee codes are as follows:

Add-On

Description

E010C

Patient with body mass index (BMI) > 40.

E011C

Patient in prone position during surgery.

E012C

Patient who is known to have malignant hyperthermia or there is a strong suspicion of susceptibility, and the anaesthetic requires full malignant hyperthermia set up and management.

E016C

ASA V – moribund patient not expected to live 24 hours with or without operation.

E017C

ASA IV – patient with incapacitating systemic disease that is a constant threat to life.

E020C

ASA E – patient undergoing anaesthesia for emergency surgery which commences within 24 hours of operating room booking, to E022C, E017C or E016C.

E021C

Premature newborn less than 37 weeks gestational age.

E022C

ASA III - patient with severe systemic disease limiting activity but not incapacitating.

E024C

Patient in sitting position during surgery, greater than 60 degrees upright.

E025C

Unanticipated massive transfusion – transfusion of at least one blood volume of red blood cells.

A (MADJ) will be run to adjust previously submitted E405A claims that paid at $0. This is tentatively scheduled for the February 2021 Remittance Advice (RA). Further details relating to the MADJ will be detailed in a future INFOBulletin.

Please Note: No action is required by physicians.

Keywords/Tags

E405A; COVID-19; Hospital Complexity; ASA; premium

For more information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.

Find INFOBulletins online on the Ministry of Health website.

Schedule of Benefits for Physician Services

The latest version of the Schedule of Benefits for Physician Services is available on the Ministry of Health website. Hard copies of the Schedule of Benefits for Physician Services will not be distributed. If you would like to order a paper copy or compact disk (CD) of the Schedule for a fee, please visit Publications Ontario. Physicians without access to the Internet can contact ServiceOntario at 1-800-668-9938.

Please review the Health Insurance Act

This bulletin is a general summary provided for information purposes only. Physicians are directed to review the Health Insurance Act, Regulation 552, and the schedules under that regulation, for the complete text of the provisions. You can access this information at ontario.ca/laws. In the event of a conflict or inconsistency between this bulletin and the applicable legislation and/or regulations, the legislation and/or regulations prevail.

For More Information

Call ServiceOntario, Infoline at:
1–866–532–3161 (Toll–free)
In Toronto, (416) 314–5518
TTY 1–800–387–5559.
In Toronto, TTY (416)327–4282
Hours of operation: Monday to Friday, 8:30am – 5:00pm

 
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