H986 – First person seen
OHIP Obstetrics Code — GENERAL PREAMBLE · Schedule of Benefits
H986 is a special visit premium for the first person seen by an Emergency Department Physician (as defined on ) when called in to see a patient for a non-elective service in the Emergency Department. This premium is applicable for services rendered during the night time period, from 00:00 to 07:00. A special visit is defined as a visit initiated by a patient or an individual on behalf of the patient for the purpose of rendering a non-elective service. The definition of an "Emergency Department Physician" for this premium is a physician: - who on a day when the physician is scheduled to work in a hospital emergency department specifically for the purpose of rendering services to patients who attend the emergency department for physician services, is requested by the emergency department to attend at a time when the physician is not otherwise scheduled to work in the emergency department; and who is not at the hospital at the time the emergency department request for attendance is made; or - is on-call on a scheduled basis specifically to be available to a hospital emergency department to render services to patients who attend the emergency department for physician services and who is not at the hospital at the time the emergency department request for attendance is made. This premium is eligible for payment only when the physician is required to travel to make a special visit to the hospital emergency department. Claims should be submitted using the appropriate A-prefix assessment fee from the “General Listings” for an assessment rendered in conjunction with this special visit premium.
When to Use
- Use H986 when you are on-call at home and are specifically requested by the ED to return to the hospital to assess a non-elective patient between 00:00 and 07:00.
- Use this code for the first patient seen during a trip initiated by an emergency call-out, provided you were not already physically present in the hospital when the request was made.
Common Pitfalls
- Billing H986 when you are already in the hospital for other duties; the premium requires that you travel to the hospital specifically for the request.
- Claiming H986 alongside Table I emergency department premiums; H986 is strictly for Table V (Emergency Department Physician) and these categories are mutually exclusive.
- Failing to document the exact time the request was received, which is a mandatory audit requirement to prove the visit was initiated by the ED.
Billing Tips
- Always pair H986 with an A-prefix assessment code (e.g., A007) to ensure the claim is processed correctly as a special visit.
- If you see subsequent patients during the same trip, use H987 for those additional patients rather than repeating H986.
Effective: April 1, 2026
GP. General Preamble
GENERAL PREAMBLE
Premium
Special Visit Premiums (Table V - Emergency Department by Emergency Department Physician)
The time of the request to attend in the emergency department must be documented on the medical record.
The specific situation requiring the physician's attendance must be documented on the medical record.
Ready to bill this code?
SnapBill makes OHIP billing simple — auto-filled codes, validation, and batch submission.