H133 – Multiple systems assessment
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A multiple systems assessment is a service rendered by a specialist in an emergency department setting, requiring a full history of the presenting complaint and detailed examination of the affected parts, regions, or systems needed to make a diagnosis, and/or exclude disease, and/or assess function. This service is for assessments provided by an Emergency Department Physician on Monday to Friday, during the evening hours of 17:00h to 24:00h. An Emergency Department Physician is defined as a physician working in a hospital emergency department or Hospital Urgent Care Clinic for the purpose of rendering services to unscheduled patients (). This fee code applies when a full- or part-time Emergency Department Physician is working for a pre-arranged designated period of time or shift, or for services rendered by an on-call physician where the service does not qualify for claiming a special visit premium.
When to Use
- Use H133 for unscheduled patients seen in the ED between 17:00 and 24:00 on weekdays when the clinical presentation requires a multi-system evaluation to reach a diagnosis.
- Use this code for patients where a standard minor assessment (H131) is insufficient due to the complexity of the history and the number of systems requiring examination.
Common Pitfalls
- Do not bill H133 in conjunction with H112 or H113, as these special visit premiums are explicitly restricted when using 'H' prefix assessment codes.
- Avoid billing H133 for patients seen outside the 17:00 to 24:00 weekday window; use the appropriate daytime or weekend 'H' code instead.
- Ensure the documentation reflects a 'multiple systems' assessment; billing H133 for a single-system complaint (e.g., simple laceration) is a common audit trigger for downcoding.
Billing Tips
- Always append the 15% age premium for patients 65 and older to maximize the value of the H133 base fee.
- If you perform separate, distinct admission orders for a patient being admitted to hospital, ensure you add H105 to the claim to capture the additional work not covered by the H133 assessment fee.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
With the exception of ultrasound guidance, (**J149) or emergency department investigative ultrasound (H100**), ultrasound services listed in this Schedule rendered by an Emergency Department Physician are not eligible for payment.
When any other service is rendered by the Emergency Department Physician in premium hours (and assessments may not be claimed), apply one of the following premiums per patient visit. | Code | Description | Asst | Surg | Anae | | :--- | :--- | :--- | :--- | :--- | | **H112** | - nights (00:00h to 08:00h) | | | | | **H113** | - daytime and evenings (08:00h to 24:00h) on Saturdays, Sundays or Holidays and Friday Evenings (17:00h to 24:00h) | | | | | **H114** | - evenings (17:00h to 24:00h) on Mondays to Thursdays | | | |
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