E412 – Emergency Department Physician evening premium
OHIP Surgical Assists Code — GENERAL PREAMBLE · Schedule of Benefits
Provides a 20% increase on the procedural fee for services performed by an Emergency Department Physician. This premium is payable only when all of the following criteria are met: 1. Time of Service: The procedure commences during one of the following periods: Evenings (17:00h – 24:00h) Monday to Friday Daytime and evenings (07:00h - 24:00h) on Saturdays, Sundays, or Holidays. 2. Nature of Service: The procedure is either: Non-elective, or An elective procedure that was delayed due to an intervening surgical emergency and commenced during the eligible time periods. 3. Applicable Services: The premium applies to one of 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: 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, J001 to J068, and X112 when required for intussusception.
When to Use
- Use E412 when performing a non-elective surgical procedure, such as a fracture reduction, within the Emergency Department during the specified evening or weekend/holiday windows.
- Apply this premium to eligible major invasive procedures (e.g., G060, G260) that are non-elective and initiated during the defined after-hours time blocks.
- Use E412 when an elective procedure is delayed by an intervening surgical emergency and subsequently commences during the eligible evening or weekend hours.
Common Pitfalls
- Do not bill E412 alongside E409 or E410, as these are restricted codes and will result in automatic claim rejection.
- Ensure the procedure code billed is explicitly listed in the E412 eligible service list; billing a procedure not included in the G-code or J-code ranges will lead to a denial.
- Avoid billing E412 for elective procedures that were not delayed by an intervening emergency, as this violates the 'Nature of Service' requirement.
Billing Tips
- Always verify that the procedure start time falls within the 17:00h–24:00h window for weekdays or the 07:00h–24:00h window for weekends/holidays to ensure the claim meets the time-of-service criteria.
- Confirm your status as an Emergency Department Physician as defined in the General Preamble (GP50) before applying this premium, as eligibility is restricted to specific provider types.
Percentage Premium: 0.2%
This code applies a percentage increase to the base procedure fee
Effective: April 3, 2020
GP. General Preamble
GENERAL PREAMBLE
PercentageIncrease
Other Premiums (including After Hours Procedure Premiums)
See General Preamble for definitions and conditions for Emergency Department Physician.
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