H134 – Re-assessment
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A re-assessment rendered by an Emergency Department Physician to an unscheduled patient in a hospital emergency department or Hospital Urgent Care Clinic. According to the Schedule, 'H' prefix listings, such as H134, apply 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. This specific code is for services rendered on Monday to Thursday between 17:00h and 24:00h. A re-assessment typically includes a relevant history and physical examination of one or more systems.
When to Use
- Use H134 for a follow-up assessment of an ED patient who remains in the department for observation or re-evaluation after an initial assessment, provided the service occurs Monday-Thursday between 17:00 and 24:00.
- Use this code when a patient returns to the ED for a re-assessment of a condition previously seen by you or another ED physician during the same shift, provided it meets the criteria for a re-assessment rather than a new consultation.
Common Pitfalls
- Billing H134 in conjunction with a Special Visit Premium (e.g., K963 or K965); H-prefix codes are strictly prohibited from being claimed with any emergency department special visit premiums.
- Using H134 for a patient who has already been discharged and returns; this code is intended for patients currently under the care of the ED during the designated shift hours.
- Confusing H134 with H131, H132, or H133; ensure the time of service strictly falls within the Monday-Thursday 17:00-24:00 window to avoid rejection.
Billing Tips
- Ensure your documentation clearly distinguishes the re-assessment from the initial assessment by highlighting new clinical findings or the evolution of the patient's condition since the last encounter.
- Verify that the service is not being claimed as a 'Consultation' (A-prefix) when the patient is already under your care in the ED, as H-prefix codes are the mandatory billing mechanism for ED physicians during their shift.
Effective: April 1, 2026
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
In addition to the common elements, all assessments must include: - A direct physical encounter with the patient including taking a patient history and performing a physical examination. - Other inquiry (including taking a patient history), carried out to arrive at an opinion as to the nature of the patient's condition, (whether such inquiry takes place before, during or after the encounter during which the physical examination takes place) and/or follow-up care. - Performing any procedure(s) during the same encounter as the physical examination, unless the procedure(s) is(are) separately listed in the Schedule and an amount is payable for the procedure in conjunction with an assessment. - Making arrangements for any related assessments, procedures or therapy, and/or interpreting results. - Making arrangements for follow-up care. - Discussion with, and providing advice and information, including prescribing therapy to the patient or the patient's representative. - When medically indicated, monitoring the condition of the patient and intervening, until the next insured service is provided.
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