H100 – Emergency department investigative ultrasound
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
An Emergency Department investigative ultrasound is only eligible for payment when: 1. the procedure is personally rendered by an Emergency Department Physician who meets standards for training and experience to render the service; 2. a specialist in Diagnostic Radiology is not available to render an urgent interpretation; and 3. the procedure is rendered for a patient that is clinically suspected of having at least one of the following life-threatening conditions: a. pericardial tamponade b. cardiac standstill c. intraperitoneal hemorrhage associated with trauma d. ruptured abdominal aortic aneurysm e. ruptured ectopic pregnancy
When to Use
- Use H100 when performing a focused assessment with sonography for trauma (FAST) to rule out intraperitoneal hemorrhage in a hemodynamically unstable patient.
- Use H100 for the rapid identification of pericardial tamponade or cardiac standstill during a cardiac arrest resuscitation when a radiologist is unavailable.
- Use H100 to confirm the presence of a ruptured abdominal aortic aneurysm or ruptured ectopic pregnancy in a patient presenting with acute shock.
Common Pitfalls
- Billing H100 for routine diagnostic ultrasounds, such as gallbladder or renal scans, will result in rejection as it is strictly limited to the five life-threatening conditions listed in the Schedule.
- Attempting to claim a special visit premium (e.g., A900 series) alongside H100 is prohibited, as H-prefix emergency department codes are explicitly excluded from these premiums.
- Failing to store a permanent record of the images and a formal interpretative report in the patient chart is a common audit failure that invalidates the claim.
Billing Tips
- Ensure your documentation explicitly links the ultrasound findings to one of the five specific life-threatening conditions to satisfy the clinical requirement for payment.
- If you perform a second scan for the same condition on the same day, you must submit it via manual review with supporting documentation to justify the necessity of the repeat procedure.
Effective: April 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Diagnostic
Diagnostic and Therapeutic Procedures, Hospital and Institutional Consultations and Assessments
The service is only eligible for payment when the Emergency Department investigative ultrasound includes both a permanent record of the image(s) and an interpretative report.
H100 is only eligible for payment when it is rendered using equipment that meets the following minimum technical requirements: 1. Images must be of a quality acceptable to allow a different physician who meets standards for training and experience to render the service to arrive at the same interpretation; 2. Scanning capabilities must include B- and M-mode; and 3. The trans-abdominal probe must be at least 3.5MHz or greater.
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