H104 – Re-assessment
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A re-assessment of a patient by an Emergency Department Physician, which requires a full, relevant history and physical examination of one or more systems. This service is for unscheduled patients in a hospital emergency department or Hospital Urgent Care Clinic. It is used by physicians working a designated shift or on-call where a special visit premium is not applicable. The H104 fee code specifically applies to services rendered on a weekday between 08:00h and 17:00h. Different codes apply for other times: H134 (evenings), H154 (weekends/holidays), and H124 (nights). As an assessment, this service includes the specific elements of assessments outlined in .
When to Use
- Use H104 for a patient who returns to the ED within the same visit for a new or worsening complaint that requires a repeat, full-system relevant physical examination.
- Use H104 for a patient who has been stabilized and requires a formal re-evaluation of their condition by the ED physician prior to a decision on discharge or admission.
- Use H104 when a patient is seen by a physician during a standard weekday shift (08:00-17:00) who was not the primary physician who performed the initial assessment.
Common Pitfalls
- Billing H104 for simple follow-up checks or nursing-led updates that do not meet the GP15 requirement for a full, relevant history and physical examination.
- Attempting to bill a Special Visit Premium (e.g., K963) alongside H104, which is strictly prohibited as H-codes are designed for shift-based work.
- Confusing H104 with H101, H102, or H103; H104 is specifically for re-assessments, whereas the others are for initial assessments of varying complexity.
Billing Tips
- Ensure the medical record explicitly documents the 'relevant history and physical examination' performed during the re-assessment to satisfy the GP15 requirements for an assessment code.
- If the patient is admitted to the hospital, you may bill H105 in addition to H104, provided the interim admission orders are rendered separately and you are not billing a separate admission assessment.
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