Billing for the Surgical Subspecialist

The following information has been summarized from the Ontario Ministry of Health and Long-Term Care Schedule of Benefits for Physician Services under the Health Insurance Act (2006). For more information, visit: www.health.gov.on.ca (Select OHIP for Healthcare Professionals and Ontario Health Insurance Schedule of Benefits)

Learning how to bill is an important skill rarely taught to the busy surgeon. This guide has been designed to provide easy links to fee codes specialty specific fee codes. Awareness of this information early on in residency will facilitate transition to practice.

1. Consultations and Visits

Go to Schedule of Benefits for Physician Services (as described above) Consultations and Visits and scroll to appropriate page.

Page            Subspecialty

A28            Cardiovascular and Thoracic Surgery

A36            General Surgery

A37            General Thoracic Surgery

A49            Neurosurgery

A52            Obstetrics and Gynaecology

A54            Ophthalmology

A56            Orthopaedic Surgery

A58            Otolaryngology

A66            Plastic Surgery

A76            Urology

2. Surgical Procedures

Go to Schedule of Benefits for Physician Services (as described above). Select the appropriate link for the surgical procedure of interest.

Section               Topic

M                       Integumentary System Surgical Procedures (Skin and subcutaneous                           tissue, operations on the breast)

N                       Musculoskeletal System Surgical Procedures (Hand, wrist, shoulder,                           skull, mandible, spine, foot, ankle, etc.)

P                        Respiratory Surgical Procedures (Nose, accessory nasal sinuses, larynx,                           trachea, lungs, chest wall, etc.)

Q                       Cardiovascular Surgical Procedures (Heart, pericardium, valves,                           arteries, veins)

R                        Haematic and Lymphatic Surgical Procedures (Spleen and marrow,                           lymph channels)

S                        Digestive System Surgical Procedures (Oropharynx, glands, esophagus,                           stomach, biliary tract, peritoneum, etc.)

T                        Urogenital and Urinary Surgical Procedures (Kidney and perinephrium,                           bladder, urethra)

U                       Male Genital Surgical Procedures (Penis, scrotum, testis, vas deferens,                           prostate, etc.)

V                        Female Genital Surgical Procedures (Vulva, introitus, vagina, cervix                           uteri, fallopian tube, ovary, etc.)

W                       Endocrine Surgical Procedures (Thyroid gland, parathyroid, thymus                           and adrenal glands)

X                        Neurological Surgical Procedures (Cranial and peripheral nerves)

Y                        Ocular and Aural Surgical Procedures (Eyeball, cornea, sclera, iris,                           external ear, middle ear, inner ear, etc.)

Z                        Spinal Surgical Procedures (Anterior and posterior spinal cord                           decompression, tumours/infections of the spine, etc.)

3. Shadow Billing:

There are many tips and tricks to ethical and efficient billing. Find a mentor known to be well versed in billing and follow him or her during practice to learn nuances of billing.

4. Most Commonly Under-billed Fees:

Learn about the most commonly under-billed fees in your specialty both in the OR and the clinic/office.