E098 – Gastroenterology chronic disease assessment premium
OHIP Surgical Assists Code — CONSULTATIONS AND VISITS · Schedule of Benefits
Gastroenterology chronic disease assessment premium is payable in addition to the amount payable for an assessment by a gastroenterology specialist (41) when all of the following criteria are met: a. The assessment is a i. medical specific assessment; ii. medical specific re-assessment; iii. complex medical specific re-assessment; or iv. partial assessment. b. The assessment is rendered in an office setting or an out-patient clinic located in a hospital, other than an emergency department. c. The patient has an established diagnosis of Crohn’s disease, Ulcerative Colitis, malnutrition, Celiac disease, or chronic liver cirrhosis, documented in the patient’s medical record.
When to Use
- Use E098 when billing A413 or A414 for a routine follow-up visit for a patient with a confirmed diagnosis of Crohn's disease or Ulcerative Colitis in your office.
- Apply E098 to A411 when performing a complex re-assessment for a patient with chronic liver cirrhosis during an outpatient hospital clinic visit.
- Use E098 with A418 for a partial assessment focused on a specific symptom flare in a patient with established Celiac disease.
Common Pitfalls
- Billing E098 for patients seen in an emergency department or as an inpatient, as the premium is strictly limited to office or outpatient clinic settings.
- Applying E098 to consultation codes (e.g., A410) rather than the specific assessment codes (A411, A413, A414, A418) listed in the schedule.
- Missing the diagnosis documentation in the chart, which is a mandatory requirement for audit compliance even if the patient is well-known to the practice.
Billing Tips
- Ensure E098 is submitted as an add-on code to the primary assessment code on the same claim to trigger the 28% premium increase.
- Verify that the patient's chronic condition is explicitly noted in the visit note to satisfy the documentation requirement for the E098 premium.
Percentage Premium: 0.28%
This code applies a percentage increase to the base procedure fee
Effective: April 1, 2023
A. Consultations and Visits
CONSULTATIONS AND VISITS
PercentageIncrease
Other Premiums (including After Hours Procedure Premiums)
The patient has an established diagnosis of Crohn’s disease, Ulcerative Colitis, malnutrition, Celiac disease, or chronic liver cirrhosis, documented in the patient’s medical record.
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