E413 – Emergency Department Physician - Night premium
OHIP Surgical Assists Code — GENERAL PREAMBLE · Schedule of Benefits
An after-hours premium that increases the procedural fee by 40% for services provided by an Emergency Department Physician. This premium is payable only when specific procedures are performed during the night, between 00:00h and 07:00h. Conditions for Payment: This premium is payable only when the following criteria are met: a. The service provided is one of the following: - 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) - One of the listed Major Invasive Procedures (see applicable codes) - X112 when required for intussusception and; b. The procedure is either: - (a) non-elective; or - (b) an elective procedure which, because of an intervening surgical emergency procedure(s), was delayed and commenced between 00:00h and 07:00h.
When to Use
- Use E413 when performing a non-elective fracture reduction or dislocation management in the ED between 00:00h and 07:00h.
- Apply E413 to eligible major invasive procedures (e.g., G-series or J-series codes) that are non-elective and initiated within the 00:00h to 07:00h window.
- Use E413 for emergency clinical procedures associated with diagnostic radiological examinations performed during the night shift.
Common Pitfalls
- Billing E413 for elective procedures that were scheduled during the day but simply finished after midnight; the procedure must be non-elective or delayed by an emergency.
- Attempting to claim E413 alongside E409 or E410, which are explicitly restricted and will result in automatic claim rejection.
- Incorrectly applying the 40% premium to the total visit fee rather than the specific procedural fee code.
Billing Tips
- Ensure the procedure start time is clearly documented in the chart, as this is the primary audit point for verifying the 00:00h to 07:00h eligibility.
- When billing, append E413 as a percentage-based add-on to the qualifying procedure code to ensure the 40% increase is calculated correctly by the system.
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