E406 – After hours premium for urgent CT/MRI interpretation - Evenings
OHIP Surgical Assists Code — OTHER PREMIUMS · Schedule of Benefits
These premiums are payable in addition to the CT or MRI services listed in the Diagnostic Radiology and Magnetic Resonance Imaging sections of the Schedule for interpreting a CT and/or MRI study on an urgent basis via a picture archiving and communication system (PACS), using diagnostic workstations and monitors consistent with Digital Imaging and Communications in Medicine (DICOM) standards. The physician must be physically present in Ontario at a location other than the hospital where the patient receives the CT or MRI study and provide the interpretation via PACS, including review of any relevant prior images available through the PACS.
When to Use
- Use E406 when you are off-site and urgently interpret a CT or MRI study requested by an ER physician or specialist during the evening hours (17:00 to 24:00).
- Apply this code when you are required to provide an urgent remote interpretation via PACS for a patient whose clinical management depends on immediate diagnostic results outside of standard hospital working hours.
Common Pitfalls
- Billing E406 in conjunction with E407 or E408 for the same patient on the same day will result in an automatic rejection.
- Failing to document the exact time of the request and the time of the transmission of the interpretation is a primary cause for audit recovery.
- Claiming the premium when you are physically present at the hospital where the study was performed violates the 'location other than the hospital' requirement.
Billing Tips
- Ensure your PACS audit log or electronic report clearly timestamps both the receipt of the urgent request and the final transmission of the interpretation to substantiate the claim during an audit.
Effective: April 1, 2025
GP. General Preamble
OTHER PREMIUMS
Premium
Other Premiums (including After Hours Procedure Premiums)
The time of the request and the time of the transmission of the interpretation.
A description of any factors referred to in the note regarding interpretation delays beyond the physician's control.
If the request for interpretation occurs prior to an eligible after hours period, but the interpretation cannot be provided prior to that eligible after hours period due to factors beyond the control of the interpreting physician, these premiums remain eligible for payment if the payment rules are otherwise satisfied.
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