H319 – Team management in a Rehabilitation Unit - twenty-seventh week onwards
OHIP Obstetrics Code — CONSULTATIONS AND VISITS · Schedule of Benefits
This service is a subsequent visit for team management in a Rehabilitation Unit for active in-patient rehabilitation, specifically for care rendered from the twenty-seventh week onwards. The note on states: 'Team management in a Rehabilitation Unit active in-patient rehabilitation management from the initiation of rehabilitation care as it applies to fee codes H312, H317 and H319 means when this service is rendered by one physiatrist even if part of the service is rendered in an active treatment hospital and part is rendered in a rehabilitation unit, the weekly and monthly limitations under the following fee codes apply to the total rehabilitation care rendered. In other words, it is not possible to claim the maximum fees allowed under C312, C317 and C319 and then start claiming de novo under H312, H317 and H319 under the above circumstances.' Per , H-prefix codes with this numbering (H3XX) are specifically for services rendered by a specialist in Physical Medicine in a rehabilitation unit.
When to Use
- Use H319 for ongoing weekly team management of a patient who has remained in active inpatient rehabilitation beyond 26 weeks.
- Apply this code when the patient has transitioned from the earlier phases covered by H312 or H317 and requires continued specialist oversight in the rehabilitation unit.
Common Pitfalls
- Attempting to reset the billing cycle by switching from C319 to H319 when a patient moves between hospital units; the Ministry aggregates these totals to enforce the monthly limit.
- Appending special visit premiums to H319, which will result in automatic rejection because H-prefix rehabilitation codes are designated as routine visits.
- Exceeding the maximum of 6 claims per patient per month, which triggers a hard rejection from the Ministry.
Billing Tips
- Ensure your total monthly claims for the patient across both C319 and H319 do not exceed the combined maximums, as the Ministry tracks these as a single cumulative rehabilitation management service.
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