E407 – After hours premium for urgent CT/MRI interpretation - Saturdays, Sundays or Holidays
OHIP Surgical Assists Code — GENERAL PREAMBLE · Schedule of Benefits
Subject to the provisions set out below, 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 E407 when you are off-site and provide an urgent interpretation of a CT or MRI via PACS on a Saturday, Sunday, or statutory holiday.
- Apply this code when the urgent management of a patient requires immediate diagnostic imaging results outside of standard hospital operating hours, provided you are not physically present at the facility.
Common Pitfalls
- Billing E407 for interpretations performed while physically present at the hospital will result in a rejection, as this code specifically requires off-site interpretation.
- Failing to document the exact time of the request and the time of the interpretation transmission is a frequent cause for audit recovery.
- Claiming E407 for non-urgent studies or routine reporting that could have been completed during standard business hours is a common compliance error.
Billing Tips
- Ensure your documentation explicitly justifies the 'urgent' nature of the request to satisfy the clinical requirement for immediate management.
- If the request was made during business hours but the interpretation was delayed to the weekend due to technical or external factors, clearly note these circumstances in the record to support the claim.
Effective: April 1, 2025
GP. General Preamble
GENERAL PREAMBLE
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 if the request for interpretation occurs prior to an eligible after hours period, but the interpretation is provided during that period due to factors beyond the control of the interpreting physician.
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.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.