E420 – Trauma premium
OHIP Surgical Assists Code — GENERAL PREAMBLE · Schedule of Benefits
The trauma premium is payable for each of the services and units described below when: a. rendered either on the day of the trauma or within 24 hours of the trauma; and b. for trauma patients age 16 or more who have an Injury Severity Score (ISS) of greater than 15, or for patients less than age 16 who have an Injury Severity Score of greater than 12. Applicable Services: The premium is applicable to the following services and units: - a. services listed in the Consultation and Visits Section (Section A of the Schedule); - b. services listed in the Obstetrics Section (K of the Schedule); - c. services listed in the Surgical Procedures section (Section M through Z of the Schedule); - d. the following resuscitative services: G395, G391, G521, G522, and G523. - e. basic and time units provided by surgical assistants; or - f. basic and time units provided by anaesthesiologists.
When to Use
- Apply E420 to surgical procedures (Sections M-Z) performed within 24 hours of a major trauma where the patient meets the specific ISS threshold.
- Use E420 when billing resuscitative services G395, G391, G521, G522, or G523 for patients meeting the age-adjusted ISS criteria.
- Apply E420 to initial consultations or subsequent visits (Section A) provided to a trauma patient within the 24-hour window, provided the ISS is documented.
Common Pitfalls
- Failing to explicitly document the calculated ISS score in the medical record, which is a mandatory requirement for audit compliance.
- Attempting to stack E420 with other special visit or after-hours premiums, which is explicitly prohibited by the General Preamble.
- Applying the premium to services outside the eligible sections, such as diagnostic imaging or laboratory interpretation codes.
Billing Tips
- Ensure the ISS score is clearly noted in the patient chart for every service code submitted with E420 to prevent automatic rejection or clawbacks during an audit.
- When billing for surgical assistants or anaesthesiologists, apply E420 to the total basic and time units rather than treating it as a standalone service code.
Percentage Premium: 0.5%
This code applies a percentage increase to the base procedure fee
Effective: July 1, 2013
GP. General Preamble
GENERAL PREAMBLE
PercentageIncrease
Other Premiums (including After Hours Procedure Premiums)
The premium is payable only for the services for which the medical record lists the ISS score.
Patient must have an Injury Severity Score (ISS) of greater than 15; or Patient must have an Injury Severity Score (ISS) of greater than 12
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