E409 – Evenings (17:00h – 24:00h) Monday to Friday or daytime and evenings on Saturdays, Sundays, Holidays - increase the procedural fee(s) by 50%
OHIP Surgical Assists Code — GENERAL PREAMBLE · Schedule of Benefits
Increases the procedural fee by 50% for specific services when performed by a physician other than an Emergency Department Physician. This premium is payable only when the procedure is either (a) non-elective, or (b) an elective procedure that was delayed due to an intervening surgical emergency, and commenced during evenings (17:00h – 24:00h, Monday to Friday) or on daytime and evenings on Saturdays, Sundays, and Holidays. This premium applies to the following services: - Non-elective Surgical Procedures (including fractures or dislocations) - Obstetrical Deliveries - Clinical Procedures Associated with Diagnostic Radiological Examinations - Ground Ambulance Transfer (K101) - Air Ambulance Transfer (K111) - Transport of Donor Organs (K102) - Return Trip (K112) - Major Invasive Procedures including: G060, G061, G062, G065, G066, G067, G068, G082, G083, G085, G090, G099, G117, G118, G119, G125, G176, G177, G178, G179, G211, G224, G246, G248, G249, G260, G261, G262, G263, G268, G269, G275, G277, G279, G280, G282, G287, G288, G290, G297, G298, G303, G309, G322, G323, G324, G330, G331, G336, G347, G348, G349, G356, G376, G379, G380, G509, services J001 to J068, and X112 when required for intussusception. This premium is not payable for procedures rendered by an Emergency Department Physician.
When to Use
- Use for non-elective surgical procedures, such as fracture reductions or acute appendectomies, performed during the defined after-hours windows.
- Use for elective procedures that were originally scheduled during daytime hours but were delayed due to an intervening surgical emergency, provided the procedure commences within the E409 time window.
- Use for obstetrical deliveries or specific diagnostic radiological procedures that meet the non-elective criteria during weekends, holidays, or weekday evenings.
Common Pitfalls
- Do not bill E409 if you are an Emergency Department Physician; this premium is strictly prohibited for ED physicians using 'H' prefix emergency service codes.
- Avoid applying E409 to elective procedures that were not delayed by an intervening surgical emergency, as this is a common audit trigger for improper premium usage.
- Ensure the procedure code itself is eligible; not every surgical code qualifies for the 50% increase, so verify the specific G-code or K-code against the GP104 list.
Billing Tips
- Always link E409 directly to the primary procedure code on your claim to ensure the 50% calculation is applied correctly to the base fee.
- When billing for delayed elective cases, maintain clear documentation of the intervening surgical emergency that caused the delay to justify the premium during a potential audit.
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