H103 – Multiple systems assessment
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A multiple systems assessment rendered by an Emergency Department Physician (EDP) to an unscheduled patient. As an 'H' prefix code, this service applies when an EDP is working a pre-arranged shift or is on-call, and the service does not qualify for a special visit premium (as per ). It is for services provided in an Emergency Department or a Hospital Urgent Care Clinic. The H103 fee is specifically for assessments performed on weekdays between 08:00h and 17:00h. Corresponding codes for other times are H133 (evenings), H153 (weekends/holidays), and H123 (nights).
When to Use
- Use H103 for a comprehensive assessment of a patient presenting with complex, multi-system complaints in the ED during standard weekday business hours (08:00-17:00).
- Select H103 when the patient requires a detailed evaluation that exceeds the scope of a minor assessment (H101) but does not meet the criteria for a formal consultation.
Common Pitfalls
- Attempting to claim a special visit premium (e.g., K962) alongside H103 will result in an automatic rejection, as H-prefix codes are strictly ineligible for these premiums.
- Billing H103 for patients seen outside the 08:00-17:00 weekday window; ensure you switch to H133, H153, or H123 based on the specific time of service to avoid claim adjustments.
- Over-billing H103 for simple, single-system presentations that are more appropriately coded as H101 (minor assessment).
Billing Tips
- Always apply the 15% age premium for patients 65 and older, as this is an automatic add-on for the H103 code family.
- If you perform admission orders for an inpatient, remember to add H105 to your H103 claim to capture the additional work, provided you are not also billing a formal admission assessment.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
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